Healthcare Provider Details

I. General information

NPI: 1649255084
Provider Name (Legal Business Name): JEROME PAUL MEYERS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: JERRY PAUL MEYERS

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121A BELLEVUE RD
DUBLIN GA
31021-2998
US

IV. Provider business mailing address

2121A BELLEVUE RD
DUBLIN GA
31021-2998
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-1190
  • Fax: 478-275-6509
Mailing address:
  • Phone: 478-275-6811
  • Fax: 478-274-7666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW000966
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: