Provider Demographics
NPI:1689144495
Name:MCCRARY, JERICA L (MPA)
Entity Type:Individual
Prefix:
First Name:JERICA
Middle Name:L
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-2227
Mailing Address - Country:US
Mailing Address - Phone:706-938-8008
Mailing Address - Fax:
Practice Address - Street 1:113B E COUNTY RD
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-2233
Practice Address - Country:US
Practice Address - Phone:706-938-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician