Healthcare Provider Details

I. General information

NPI: 1346201472
Provider Name (Legal Business Name): JILL HUGHES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 CHATTAHOOCHEE WINDS DR
DEMOREST GA
30535-3200
US

IV. Provider business mailing address

122 CHATTAHOOCHEE WINDS DR
DEMOREST GA
30535-3200
US

V. Phone/Fax

Practice location:
  • Phone: 706-768-1233
  • Fax:
Mailing address:
  • Phone: 706-768-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW002968
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000893604B
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 2
Identifier000893604A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 3
Identifier1245958065
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: