Provider Demographics
NPI:1255512521
Name:RAMSEY, JACQUELYN L (MSW002670)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:L
Last Name:RAMSEY
Suffix:
Gender:F
Credentials:MSW002670
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1501
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-1007
Mailing Address - Country:US
Mailing Address - Phone:404-286-0054
Mailing Address - Fax:404-286-0064
Practice Address - Street 1:4484 COVINGTON HWY
Practice Address - Street 2:SUITE 100-A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1203
Practice Address - Country:US
Practice Address - Phone:404-286-0054
Practice Address - Fax:404-286-0064
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW002670251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health