Healthcare Provider Details

I. General information

NPI: 1598456220
Provider Name (Legal Business Name): JAMIE MOQUIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 JOHNSTON ST
SAVANNAH GA
31405-5502
US

IV. Provider business mailing address

209 7TH ST FL 3
AUGUSTA GA
30901-1486
US

V. Phone/Fax

Practice location:
  • Phone: 706-842-5330
  • Fax: 706-842-5340
Mailing address:
  • Phone: 706-842-5330
  • Fax: 706-842-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-63003
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: