Provider Demographics
NPI:1821035700
Name:BEDELL, JEANNE E (MSW)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:E
Last Name:BEDELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 PHOENIX BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5545
Mailing Address - Country:US
Mailing Address - Phone:770-997-8516
Mailing Address - Fax:770-991-9014
Practice Address - Street 1:1631 PHOENIX BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5545
Practice Address - Country:US
Practice Address - Phone:770-997-8516
Practice Address - Fax:770-991-9014
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0002681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBBNHMedicare ID - Type Unspecified
GAR13001Medicare UPIN