Provider Demographics
NPI:1245630136
Name:RAWLS, JEWANDRA
Entity type:Individual
Prefix:
First Name:JEWANDRA
Middle Name:
Last Name:RAWLS
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 1:723 RIVER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-5793
Mailing Address - Country:US
Mailing Address - Phone:678-520-6043
Mailing Address - Fax:
Practice Address - Street 1:723 RIVER VALLEY DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-5793
Practice Address - Country:US
Practice Address - Phone:678-520-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst