MEDICARE: JENNIFER GILREATH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1043670870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GILREATH

Provider Business Mailing Address
First Line	:	5560 HAIR LAKE RD
Second Line	:
City	:	SUMMERVILLE
State	:	GA
Zip	:	30747-6301
Country	:	US
Telephone Number	:	706-978-1330
Fax Number	:

Provider Business Practice Location Address
First Line	:	3395 SIXES RD
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-9125
Country	:	US
Telephone Number	:	678-880-8385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	03/07/2016

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