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NPI Code Detail

MEDICARE: JESSICA DORAN

MEDICARE: JESSICA DORAN
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1740706332
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA DORAN
Provider Business Mailing Address
First Line : 5921 BEMISS RD
Second Line :
City : VALDOSTA
State : GA
Zip : 31605-7520
Country : US
Telephone Number : 407-353-5168
Fax Number :
Provider Business Practice Location Address
First Line : 5921 BEMISS RD
Second Line :
City : VALDOSTA
State : GA
Zip : 31605-7520
Country : US
Telephone Number : 407-353-5168
Fax Number : 407-353-5168
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2017
Last Update Date : 08/16/2017

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Directions to “ JESSICA DORAN ” Practice Location

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