MEDICARE: JBORDLEON & ASSOCIATES, LLC

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1396921789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JBORDLEON & ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 76029
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30358-1029
Country	:	US
Telephone Number	:	678-431-0916
Fax Number	:

Provider Business Practice Location Address
First Line	:	1217 CLUB WALK DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-2672
Country	:	US
Telephone Number	:	678-431-0916
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	JACQUELINE M BORDLEON
Credential	:
Telephone Number	:	678-431-0916

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	01/15/2008

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