MEDICARE: JESSICA 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	MSW007934	GA
2	1041C0700X	Clinical Social Worker	CSW007311	GA

General Provider Information

NPI Number	:	1275058711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA PEREZ LCSW

Provider Business Mailing Address
First Line	:	4125 ATLANTA RD SE STE 120
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6526
Country	:	US
Telephone Number	:	708-585-3777
Fax Number	:	770-874-3310

Provider Business Practice Location Address
First Line	:	4125 ATLANTA RD SE STE 120
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6526
Country	:	US
Telephone Number	:	770-858-5377
Fax Number	:	404-874-3310

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

Provider Enumeration Date	:	08/05/2017
Last Update Date	:	04/10/2023

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Directions to “ JESSICA PEREZ LCSW” Practice Location

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