Provider Demographics
NPI:1154027902
Name:NOLES, JEREMY HOUSTON
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:HOUSTON
Last Name:NOLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 BARRON DR
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-5502
Mailing Address - Country:US
Mailing Address - Phone:706-768-1620
Mailing Address - Fax:
Practice Address - Street 1:546 BARRON DR
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-5502
Practice Address - Country:US
Practice Address - Phone:706-768-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW010891104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker