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General NPI Number Information
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NPI Number | 1720622848
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Entity Type | Individual
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Provider Name | JAMIE CAROL FERNANDEZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/31/2019
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 317 W HILL ST STE 203B
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City | DECATUR
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State | GA
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Zip | 30030-4368
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Country | US
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Telephone | 470-207-1487
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Fax |
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Provider Business Mailing Address
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Address Line | 1375 MOSSWOOD LN SE
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City | SMYRNA
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State | GA
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Zip | 30082-3956
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Country | US
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Telephone | 770-312-6834
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW006238
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License Number State | GA
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