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NPI Code Detail

MEDICARE: JANA PRUETT COVINGTON LCSW

MEDICARE: JANA PRUETT COVINGTON LCSW
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
11041C0700XClinical Social WorkerCSW004206GA

General Provider Information

NPI Number : 1760702781
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANA PRUETT COVINGTON LCSW
Provider Business Mailing Address
First Line : 597 WILLARD AVE SW
Second Line :
City : ATLANTA
State : GA
Zip : 30310-1541
Country : US
Telephone Number : 404-502-7660
Fax Number :
Provider Business Practice Location Address
First Line : 5887 GLENRIDGE DR STE 230
Second Line :
City : ATLANTA
State : GA
Zip : 30328-9929
Country : US
Telephone Number : 317-721-6550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2010
Last Update Date : 11/23/2024

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Directions to “ JANA PRUETT COVINGTON LCSW” Practice Location

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