Provider Demographics
NPI:1104326834
Name:JACOBS, BRENDA SNOW
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SNOW
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5308
Mailing Address - Country:US
Mailing Address - Phone:678-600-6704
Mailing Address - Fax:
Practice Address - Street 1:147 SUMMERFIELD DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5308
Practice Address - Country:US
Practice Address - Phone:678-600-6704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child