MEDICARE: JORDAN SEABOLT POOLE

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1497096382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN SEABOLT POOLE

Provider Business Mailing Address
First Line	:	11 WESTCHESTER DR
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30120-6448
Country	:	US
Telephone Number	:	770-547-0010
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 COLONIAL CENTER PKWY STE 100N
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-4892
Country	:	US
Telephone Number	:	703-506-0123
Fax Number	:	866-857-0246

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

Provider Enumeration Date	:	03/03/2013
Last Update Date	:	05/21/2021

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Directions to “ JORDAN SEABOLT POOLE ” Practice Location

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