=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689806002
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANE R FURTNER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2009
-----------------------------------------------------
Last Update Date | 08/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6755 PEACHTREE INDUSTRIAL BLVD STE 110
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30360-2223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-825-0448
-----------------------------------------------------
Fax | 770-451-9731
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4481 PINERIDGE CIR
-----------------------------------------------------
City | DUNWOODY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30338-6540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-825-0448
-----------------------------------------------------
Fax | 770-451-9731
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JANE R FURTNER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 770-825-0448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW001270
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------