MEDICARE: JESSICA M HALLMAN

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	101YP2500X	Professional Counselor	LPC012166	GA

General Provider Information

NPI Number	:	1558937649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA M HALLMAN

Provider Business Mailing Address
First Line	:	PO BOX 1027
Second Line	:
City	:	REX
State	:	GA
Zip	:	30273-8027
Country	:	US
Telephone Number	:	678-831-7377
Fax Number	:	678-487-5340

Provider Business Practice Location Address
First Line	:	40 MACON ST STE D
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-3233
Country	:	US
Telephone Number	:	678-831-7377
Fax Number	:	678-487-5340

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

Provider Enumeration Date	:	05/31/2021
Last Update Date	:	05/31/2021

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