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NPI Code Detail

MEDICARE: JIMMY ENOBABOR

MEDICARE: JIMMY ENOBABOR
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
1101YP2500XProfessional Counselor009486GA

General Provider Information

NPI Number : 1184408049
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIMMY ENOBABOR
Provider Business Mailing Address
First Line : 244 COMMERCE DR
Second Line :
City : DECATUR
State : GA
Zip : 30030-1966
Country : US
Telephone Number : 817-987-3385
Fax Number :
Provider Business Practice Location Address
First Line : 175 GWINNETT DR
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30046-8444
Country : US
Telephone Number : 678-209-2394
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2023
Last Update Date : 01/15/2026

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Directions to “ JIMMY ENOBABOR ” Practice Location

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