Provider Demographics
NPI:1912380080
Name:HOPE, JERRY WAYNE JR
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:WAYNE
Last Name:HOPE
Suffix:JR
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 1:2395 HIGHWAY 36 E
Mailing Address - Street 2:
Mailing Address - City:MILNER
Mailing Address - State:GA
Mailing Address - Zip Code:30257-3320
Mailing Address - Country:US
Mailing Address - Phone:770-354-2102
Mailing Address - Fax:770-412-8576
Practice Address - Street 1:2395 HIGHWAY 36 E
Practice Address - Street 2:
Practice Address - City:MILNER
Practice Address - State:GA
Practice Address - Zip Code:30257-3320
Practice Address - Country:US
Practice Address - Phone:770-354-2102
Practice Address - Fax:770-412-8576
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator