Most Relevant Information
Provider Data
| NPI Number: | 1003532003 |
| Provider Name: | JAIME PENN |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/12/2022 |
| Last Updated: | 10/12/2022 |
Provider Practice Location
2226 ACAPULCO DR APT C
AUGUSTA
GA
309062376
Practice Location Phone/Fax
| Phone: | 7067509442 |
| Fax: |
Provider Mailing Location
PO BOX 16441
AUGUSTA
GA
309192441
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |