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General NPI Number Information
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NPI Number | 1962540989
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Entity Type | Organization
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Legal Business Name | JEHOVAH JIREH ENTERPRISES, LLC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 5534 OLD NATIONAL HIGHWAY SUITE 150E
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City | COLLEGE PARK
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State | GA
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Zip | 30349
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Country | US
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Telephone | 404-993-1146
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Fax | 678-799-7651
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Provider Business Mailing Address
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Address Line | 5534 OLD NATIONAL HIGHWAY SUITE 150E
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City | COLLEGE PARK
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State | GA
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Zip | 30349
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Country | US
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Telephone | 404-993-1146
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Fax | 678-799-7651
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Authorized Official
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Title or Position | OWNER CEO
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Name | JACQUELINE SWEEZER
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Credential |
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Telephone | 404-993-1146
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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 | CSW002826
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License Number State | GA
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