MEDICARE: MRS. JERI ELIZABETH BLANCHARD

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	106S00000X	Behavior Technician	22-221875	GA

General Provider Information

NPI Number	:	1659003267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JERI ELIZABETH BLANCHARD

Provider Business Mailing Address
First Line	:	3518 VETERANS PKWY STE A-F
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-7152
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3518 VETERANS PKWY STE A-F
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-7152
Country	:	US
Telephone Number	:	706-315-6393
Fax Number	:

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

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	06/30/2022

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