Healthcare Provider Details

I. General information

NPI: 1548095052
Provider Name (Legal Business Name): JENNIFER NICOLE RICE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 HIGHWAY 19 N
ZEBULON GA
30295-3189
US

IV. Provider business mailing address

1443 HENDRICKS CHURCH RD
THOMASTON GA
30286-2043
US

V. Phone/Fax

Practice location:
  • Phone: 770-567-7500
  • Fax:
Mailing address:
  • Phone: 770-318-9446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2386
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: