MEDICARE: JESSICA OCHEI-GILLIAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW007243	GA

General Provider Information

NPI Number	:	1659988434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA OCHEI-GILLIAM

Provider Business Mailing Address
First Line	:	3623 SUMMIT PNES
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-3856
Country	:	US
Telephone Number	:	678-982-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 THE EXCHANGE SE STE 220
Second Line	:	PMB 317136
City	:	ATLANTA
State	:	GA
Zip	:	30339-2171
Country	:	US
Telephone Number	:	770-728-8773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	06/09/2025

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