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NPI Code Detail

MEDICARE: MARQUII JACOBS BCABA

MEDICARE: MARQUII JACOBS BCABA
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 Technician
2390200000XStudent in an Organized Health Care Education/Training ProgramFL

General Provider Information

NPI Number : 1629404371
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARQUII JACOBS BCABA
Provider Business Mailing Address
First Line : 27 LITCHFIELD DR
Second Line :
City : SAVANNAH
State : GA
Zip : 31419-7501
Country : US
Telephone Number : 912-373-5613
Fax Number : 305-597-3863
Provider Business Practice Location Address
First Line : 105 GRAND CENTRAL BLVD STE 101
Second Line :
City : POOLER
State : GA
Zip : 31322-4146
Country : US
Telephone Number : 470-394-0004
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2013
Last Update Date : 06/07/2021

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Directions to “ MARQUII JACOBS BCABA” Practice Location

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