MEDICARE: AARON MAXIMO PEREZ LCSW

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	1041C0700X	Clinical Social Worker	CSW006966	GA

General Provider Information

NPI Number	:	1205460987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON MAXIMO PEREZ LCSW

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 WHITE SULPHUR RD STE 260
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-2569
Country	:	US
Telephone Number	:	678-368-8793
Fax Number	:

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

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	01/21/2021

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