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General NPI Number Information
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NPI Number | 1568664563
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Entity Type | Organization
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Legal Business Name | JILL OVERCASH LLC
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 945 RIVER CENTRE PLACE SUITE 200
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043
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Country | US
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Telephone | 678-646-0404
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Fax | 678-646-0202
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Provider Business Mailing Address
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Address Line | 1150 STEEPLE RUN
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-4038
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Country | US
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Telephone | 678-646-0404
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Fax | 678-646-0202
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Authorized Official
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Title or Position | CEO
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Name | DR. JILL JOWERS OVERCASH
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Credential | M.D. FAAP
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Telephone | 678-261-7455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 051340
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License Number State | GA
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