Provider Demographics
NPI:1821608787
Name:DEAN, JOANN SMITH (MSW, BCC)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:SMITH
Last Name:DEAN
Suffix:
Gender:F
Credentials:MSW, BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1878 MILLSTREAM HOLW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3504
Mailing Address - Country:US
Mailing Address - Phone:770-634-0910
Mailing Address - Fax:
Practice Address - Street 1:1878 MILLSTREAM HOLW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3504
Practice Address - Country:US
Practice Address - Phone:770-634-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA768171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor