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General NPI Number Information
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NPI Number | 1164774741
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Entity Type | Organization
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Legal Business Name | OPERATION J.U.M.P., INC.
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 2622 SYLVAN RD
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City | EAST POINT
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State | GA
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Zip | 30344-6738
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Country | US
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Telephone | 404-767-5554
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Fax |
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Provider Business Mailing Address
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Address Line | 2622 SYLVAN RD
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City | ATLANTA
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State | GA
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Zip | 30344-6738
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Country | US
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Telephone | 404-767-5554
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. BEVERLY ASHBY
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Credential | PH.D.
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Telephone | 404-767-5554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC006041
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License Number State | GA
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