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NPI Code Detail

MEDICARE: JADA IMANI BARKSDALE OTD

MEDICARE: JADA IMANI BARKSDALE OTD
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
1106S00000XBehavior Technician
2106S00000XBehavior TechnicianRBT-20-119199GA

General Provider Information

NPI Number : 1093325227
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADA IMANI BARKSDALE OTD
Provider Business Mailing Address
First Line : 3 SILVER OAK CT
Second Line :
City : POOLER
State : GA
Zip : 31322-4012
Country : US
Telephone Number : 912-656-4794
Fax Number :
Provider Business Practice Location Address
First Line : 100 COMMERCE CT
Second Line :
City : POOLER
State : GA
Zip : 31322-9445
Country : US
Telephone Number : 615-560-6622
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2020
Last Update Date : 03/27/2025

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Directions to “ JADA IMANI BARKSDALE OTD” Practice Location

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