JACLYN ETHRIDGE (NPI# 1205319241) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205319241 |
| Entity Type | Individual |
| Full Name | JACLYN ETHRIDGE |
| Credential | LPC |
| Practice Address |
1574 Williamson Rd Griffin GA 30224-3931 |
| Practice Telephone | 7703585252 |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2018-09-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
LPC010462 | GA | Behavioral Health & Social Service Providers |
| Street Address |
1574 WILLIAMSON RD |
| City | GRIFFIN |
| State | GA |
| Zip Code | 30224-3931 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013137165 | Joyce Christine Darden | Counselor | 1574 Williamson Rd, Griffin, GA 30224-3931 | 2007-04-30 |
| 1710541263 | Melissa Blanton | Licensed Practical Nurse | 1574 Williamson Rd, Griffin, GA 30224-3931 | 2019-04-30 |
| 1306320718 | Shayne Moore | Counselor | 1574 Williamson Rd, Griffin, GA 30223 | 2018-09-20 |
| 1386128320 | Gloria Chine | Nurse Practitioner | 1574 Williamson Rd, Griffin, GA 30224 | 2018-09-15 |
| 1932575016 | Andrew Leo Gray | Counselor | 1574 Williamson Rd, Griffin, GA 30224-3931 | 2015-08-12 |
| 1124363874 | Jamie Alice Smith | Nurse Practitioner | 1574 Williamson Rd, Griffin, GA 30224-3931 | 2012-12-06 |
| 1073878591 | Linda Mae Fulop | Counselor | 1574 Williamson Rd, Griffin, GA 30224-3931 | 2012-07-10 |
| 1538330170 | Charlene Pugh | Registered Nurse | 1574 Williamson Rd, Griffin, GA 30224-3931 | 2008-03-21 |
| 1295903862 | Mcintosh Trail Csb | Community/Behavioral Health | 1574 Williamson Rd, Griffin, GA 30224-3931 | 2008-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346888971 | Latamika Renee Williams | Counselor | 1710 Ga-16 West, #6, Griffin, GA 30224 | 2019-12-13 |
| 1063062651 | Dominique S Paul-thompson | Contractor | 112 Deercreek Parkway, Griffin, GA 30224 | 2019-09-16 |
| 1497303531 | Xiaohui Zhang Brotzge | Physician Assistant | 601 S 8th Street, Griffin, GA 30224 | 2019-09-02 |
| 1548812282 | Andrew Dennis Nesmith | Registered Nurse | 601 South 8th St, Emergency Room, Griffin, GA 30224 | 2019-07-12 |
| 1073009122 | Alicia Skye Ledford | Nurse Practitioner | 619 S 8th St., Suite 200, Griffin, GA 30224 | 2018-07-02 |
| 1649787102 | Judith Fuajong Ngulefac | Nurse Practitioner | 1705 Williamson Rd, Griffin, GA 30224 | 2018-01-05 |
| 1699297077 | Amanda Norman | Speech-Language Pathologist | 106 Garnet Ln, Griffin, GA 30224 | 2017-07-07 |
| 1306214655 | Ruchi P Gandhi | Optometrist | 646 8th Street, Griffin, GA 30224 | 2015-09-03 |
| 1528473881 | Nnenna Ezeilo | Otolaryngology | 619 S 8th St Ste 304, Griffin, GA 30224 | 2014-06-25 |
| 1437436094 | C. B. Reddy Md PC | Preferred Provider Organization | 610 S 8th Street, Suite F, Griffin, GA 30224 | 2011-11-10 |
| Find all providers in zip 30224 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952757395 | Brighter Tomorrows Consulting, LLC | Counselor | 1815 N Expressway, Suite B, Griffin, GA 30223-1185 | 2016-05-04 |
| 1306202247 | Linda Langston, Lpc & Associates Inc. | Counselor | 216 Begonia Ct, Griffin, GA 30223-5879 | 2016-01-07 |
| 1508235466 | Trenisha Jones Mccall | Counselor | 1815 North Expressway, Griffin, GA 30223 | 2015-09-22 |
| 1104224948 | Dawn Tyus | Counselor | 424 W. Taylor Street, Griffin, GA 30223 | 2014-12-10 |
| 1326471715 | Gwendolyn Machelle Garland | Counselor | 1104 N 2nd St, Griffin, GA 30223-1643 | 2013-08-20 |
| 1104197961 | Craig Aric Dunn | Counselor | 244 Odell Rd Ste 6, Griffin, GA 30224-4878 | 2012-01-25 |
| 1679809016 | Shannon M Eller | Counselor | 1815 N Expressway Ste B, Griffin, GA 30223-1185 | 2009-10-20 |
| 1598098006 | Aaron Roquemore | Counselor | 210 S 13th St, Griffin, GA 30224 | 2009-09-15 |
| 1427291822 | Pam Beckham | Counselor | 40 Lily Ln, Griffin, GA 30224-7387 | 2009-04-14 |
| 1063661510 | Edward E Scudder | Counselor | 615 Windy Hill Rd, Griffin, GA 30224-5330 | 2008-09-09 |
| Find all providers in GRIFFIN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.