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NPI Code Detail

MEDICARE: JERICHA MITCHEM

MEDICARE: JERICHA MITCHEM
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 TechnicianRBT-21-175847SC
2103K00000XBehavior Analyst1-24-71781GA

General Provider Information

NPI Number : 1275208860
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERICHA MITCHEM
Provider Business Mailing Address
First Line : PO BOX 2567
Second Line :
City : AUGUSTA
State : GA
Zip : 30903-2567
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Provider Business Practice Location Address
First Line : 601 INSPERON DR
Second Line :
City : GROVETOWN
State : GA
Zip : 30813-0609
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2021
Last Update Date : 03/12/2024

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Directions to “ JERICHA MITCHEM ” Practice Location

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