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General NPI Number Information
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NPI Number | 1518600311
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Entity Type | Individual
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Provider Name | JANNORA GAMBLE
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Gender | Female
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 250 GEORGIA AVE SE STE 206
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City | ATLANTA
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State | GA
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Zip | 30312-3000
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Country | US
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Telephone | 404-653-0374
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Fax |
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Provider Business Mailing Address
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Address Line | 4287 GREGORY CT SW
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City | SMYRNA
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State | GA
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Zip | 30082-4426
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Country | US
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Telephone | 856-357-6874
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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