Provider Demographics
NPI:1063980555
Name:JOLLEY, KAREN GRIFFIN (CPS, CPRP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:GRIFFIN
Last Name:JOLLEY
Suffix:
Gender:F
Credentials:CPS, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 ROWLAND RD
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-9502
Mailing Address - Country:US
Mailing Address - Phone:478-719-6849
Mailing Address - Fax:
Practice Address - Street 1:940 GA HIGHWAY 96
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2584
Practice Address - Country:US
Practice Address - Phone:478-988-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist