MEDICARE: DANIELLE JURKOVICH MSSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1972283455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE JURKOVICH MSSW

Provider Business Mailing Address
First Line	:	380 DAHLONEGA ST STE 100
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-8219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 DAHLONEGA ST STE 100
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-8219
Country	:	US
Telephone Number	:	678-737-4430
Fax Number	:

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

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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