Provider Demographics
NPI:1891316444
Name:TROTMAN, JERON
Entity Type:Individual
Prefix:
First Name:JERON
Middle Name:
Last Name:TROTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3348 PEACHTREE RD NE STE 700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1682
Mailing Address - Country:US
Mailing Address - Phone:615-570-9959
Mailing Address - Fax:646-859-4440
Practice Address - Street 1:3348 PEACHTREE RD NE STE 700
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1682
Practice Address - Country:US
Practice Address - Phone:615-570-9959
Practice Address - Fax:646-859-4440
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-16-23062103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst