MAXIMILLIAN A JEFFERIES (NPI# 1831529395) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831529395 |
| Entity Type | Individual |
| Full Name | MAXIMILLIAN A JEFFERIES |
| Credential | LPC, NCC, MFT |
| Practice Address |
100 Lloyd Ave Ste E Tyrone GA 30290-2157 |
| Mailing Address |
445 Winn Way Decatur GA 30030-1707 |
| Practice Telephone | 4049016570 |
| Practice Fax Number | 6788702274 |
| Mailing Telephone | 4045087700 |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2019-02-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
LPC007538 | GA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 461399935 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 445 Winn Way, Decatur, GA 300301707 | 4045087700 |
| Street Address |
100 LLOYD AVE STE E |
| City | TYRONE |
| State | GA |
| Zip Code | 30290-2157 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407215361 | Kaitlin Lackey | Occupational Therapist | 105 Glendalough Court, Suite H, Tyrone, GA 30290 | 2016-02-19 |
| 1114211745 | Johannes Daniel Smit | Pharmacist | 525 Valleywood Drive, Tyrone, GA 30290 | 2011-05-31 |
| 1760700199 | Georgia Integrative Medicine | Preventive Medicine | 120 Milbrook Village Drive, Suite E, Tyrone, GA 30290 | 2010-05-10 |
| 1427384783 | Exelle Home Care | Home Health | 105 Silverthorn Drive, Tyrone, GA 30290 | 2009-10-21 |
| 1386884138 | Genesys Ob/gyn, LLC | Clinic/Center | 245 Greencastle Road, Tyrone, GA 30290 | 2009-03-05 |
| 1689858805 | Immediate Care Centers of Georgia, LLC | Clinic/Center | 190 Greencastle Rd., Tyrone, GA 30290 | 2007-12-24 |
| 1437212834 | Dawn M Coffman | Physician Assistant | 190 Handley Rd., Tyrone, GA 30290 | 2006-12-18 |
| 1912971805 | Jason Rex Lee | Dentist | 195 Greencastle Rd, Tyrone, GA 30290 | 2006-02-15 |
| 1053898759 | Heather Renee Ellis | Physical Therapist | 62 Carriage Oaks Dr, Tyrone, GA 30290 | 2018-07-25 |
| 1134630858 | Marjorie Yvette Elibert | Advanced Practice Midwife | 190 Handley Rd Ste A, Tyrone, GA 30290 | 2017-10-20 |
| Find all providers in zip 30290 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790397164 | Lotus Center for Counseling and Wellness LLC | Counselor | 155 Newfield Dr, Tyrone, GA 30290-2570 | 2020-08-18 |
| 1194244731 | Pamela Elder Pinckney | Counselor | 179 Handley Rd Ste D8, Tyrone, GA 30290-2152 | 2017-09-14 |
| 1942588454 | Elizabeth S. Roberts | Counselor | 315 Dogwood Trl, Tyrone, GA 30290-2916 | 2011-08-01 |
| 1104140573 | Jane Constance Jones | Counselor | 100 Glendalough Ct, Suite E, Tyrone, GA 30290-2942 | 2010-03-15 |
| 1578886545 | Melinda English Kantor | Counselor | 100 Glendalough Ct Ste E, Tyrone, GA 30290-2942 | 2010-03-05 |
| 1912138058 | John Bernard Mcintosh | Counselor | 221 Hospital Dr, Suite 1, Tyrone, PA 16686-1809 | 2009-08-06 |
| 1144378605 | Elizabeth Ream | Counselor | 120 Handley Rd Ste 310, Tyrone, GA 30290-2173 | 2007-01-08 |
| 1548252323 | Kristi L Maxwell | Counselor | 105 Greencastle Rd, Suite B, Tyrone, GA 30290-2937 | 2005-08-18 |
| 1962029702 | Fatema Shabbir Harianawala | Counselor | 120 Handley Rd Ste 310, Tyrone, GA 30290-2173 | 2020-06-27 |
| 1356750806 | Hope H Morgan | Counselor | 100 Glendalough Ct Ste E, Tyrone, GA 30290-2942 | 2014-08-08 |
| Find all providers in TYRONE | ||||
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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.