Provider Demographics
NPI:1689806002
Name:JANE R FURTNER INC
Entity Type:Organization
Organization Name:JANE R FURTNER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FURTNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-825-0448
Mailing Address - Street 1:4481 PINERIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6540
Mailing Address - Country:US
Mailing Address - Phone:770-825-0448
Mailing Address - Fax:770-451-9731
Practice Address - Street 1:6755 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:STE 110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30360-2223
Practice Address - Country:US
Practice Address - Phone:770-825-0448
Practice Address - Fax:770-451-9731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0012701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA611047524AMedicaid
GAR61756Medicare UPIN
GA80BBCKMMedicare PIN