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NPI Code Detail

MEDICARE: JORDAN LACY CALVIN

MEDICARE: JORDAN LACY CALVIN
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

General Provider Information

NPI Number : 1770332298
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN LACY CALVIN
Provider Business Mailing Address
First Line : 319 CANTON RD
Second Line :
City : CUMMING
State : GA
Zip : 30040-2213
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 319 CANTON RD
Second Line :
City : CUMMING
State : GA
Zip : 30040-2213
Country : US
Telephone Number : 470-239-2237
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2024
Last Update Date : 05/16/2024

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Directions to “ JORDAN LACY CALVIN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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