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General NPI Number Information
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NPI Number | 1376604165
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Entity Type | Individual
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Provider Name | ANNELLE JEAN-JACQUES LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 5005 SUNBROOK WAY NW
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City | ACWORTH
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State | GA
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Zip | 30101-8031
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Country | US
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Telephone | 770-974-1061
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Fax | 770-974-8354
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Provider Business Mailing Address
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Address Line | 5005 SUNBROOK WAY NW
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City | ACWORTH
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State | GA
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Zip | 30101-8031
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Country | US
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Telephone | 770-974-1061
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Fax | 770-974-8354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | MSW002232
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License Number State | GA
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