Individual
MS. ANNELLE JEAN-JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
5005 SUNBROOK WAY NW, ACWORTH, GA 30101-8031
(770) 974-1061
(770) 974-8354
Mailing address
5005 SUNBROOK WAY NW, ACWORTH, GA 30101-8031
(770) 974-1061
(770) 974-8354
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
MSW002232
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00809366B
—
GA
01
—
10041078
AMERIGROUP PRACTITIONER #
GA
01
—
10041079
AMERIGROUP PRACTITIONER #
GA
Enumeration date
12/13/2006
Last updated
07/09/2007
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