MEDICARE: JAZZIELL ALLEN

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	106S00000X	Behavior Technician		GA

General Provider Information

NPI Number	:	1104758515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZZIELL ALLEN

Provider Business Mailing Address
First Line	:	1212 AUGUSTA WEST PKWY STE 1B
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-1808
Country	:	US
Telephone Number	:	706-826-2770
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 FURYS FERRY RD STE 210
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-4729
Country	:	US
Telephone Number	:	706-826-2770
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ JAZZIELL ALLEN ” Practice Location

Language	Start Address	Practice Location

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