MEDICARE: THOMAS M JARVIS ED.D.

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	LPC006081	GA

General Provider Information

NPI Number	:	1700185279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS M JARVIS ED.D.

Provider Business Mailing Address
First Line	:	789 FOREST LAKE DR S
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31210-3237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	789 FOREST LAKE DR S
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31210-3237
Country	:	US
Telephone Number	:	478-477-5818
Fax Number	:

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

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	03/22/2011

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