Provider Demographics
NPI:1194865378
Name:FROST, JERRI LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JERRI
Middle Name:LYNN
Last Name:FROST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JERRI
Other - Middle Name:L
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:9625 HIGHWAY 280 EAST
Mailing Address - Street 2:PO BOX 958
Mailing Address - City:ELLABELL
Mailing Address - State:GA
Mailing Address - Zip Code:31308-0958
Mailing Address - Country:US
Mailing Address - Phone:706-490-2555
Mailing Address - Fax:
Practice Address - Street 1:1569 HIGHWAY 21 S
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-5214
Practice Address - Country:US
Practice Address - Phone:706-490-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW 0031221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10045584OtherAMERIGROUP
GA312364857AMedicaid
GA312364857BMedicaid
GA729151-000OtherWELLCARE