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Individual
MR. CASWELL MILES JEFFERSON III
Active
Individual
MR. CASWELL MILES JEFFERSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0000004021
TN
235Z00000X
Speech-Language Pathologist
SLP006493
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
571152749
TRICARE
GA
01
—
766969817A
PEACHSTATE
GA
05
—
766969817A
—
GA
01
—
PENDING
WELLCARE
GA
Enumeration date
04/11/2007
Last updated
03/21/2022
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