MEDICARE: JO ANNE RAGSDALE

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1073121646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO ANNE RAGSDALE

Provider Business Mailing Address
First Line	:	4916 LAKE PARK LN
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-6253
Country	:	US
Telephone Number	:	678-447-2975
Fax Number	:

Provider Business Practice Location Address
First Line	:	4916 LAKE PARK LN
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-6253
Country	:	US
Telephone Number	:	678-447-2975
Fax Number	:

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

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/20/2020

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