Provider Demographics
NPI:1073121646
Name:RAGSDALE, JO ANNE
Entity Type:Individual
Prefix:
First Name:JO ANNE
Middle Name:
Last Name:RAGSDALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4916 LAKE PARK LN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-6253
Mailing Address - Country:US
Mailing Address - Phone:678-447-2975
Mailing Address - Fax:
Practice Address - Street 1:4916 LAKE PARK LN
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-6253
Practice Address - Country:US
Practice Address - Phone:678-447-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services