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NPI Code Detail

MEDICARE: VICKIE M JESTER LCSW

MEDICARE: VICKIE M JESTER 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 Worker001351GA

General Provider Information

NPI Number : 1972692796
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICKIE M JESTER LCSW
Provider Business Mailing Address
First Line : 2029 MARK TRL
Second Line :
City : DECATUR
State : GA
Zip : 30032-5350
Country : US
Telephone Number : 404-377-7052
Fax Number :
Provider Business Practice Location Address
First Line : 1636 CONNALLY DR
Second Line :
City : EAST POINT
State : GA
Zip : 30344-2558
Country : US
Telephone Number : 404-762-4042
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 07/08/2007

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