Provider Demographics
NPI:1194865378
Name:FROST, JERRI LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JERRI
Middle Name:LYNN
Last Name:FROST
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JERRI
Other - Middle Name:L
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLET
Mailing Address - State:GA
Mailing Address - Zip Code:30415-0002
Mailing Address - Country:US
Mailing Address - Phone:706-490-2555
Mailing Address - Fax:
Practice Address - Street 1:110 PARKER AVE S
Practice Address - Street 2:
Practice Address - City:BROOKLET
Practice Address - State:GA
Practice Address - Zip Code:30415-8208
Practice Address - Country:US
Practice Address - Phone:706-490-2555
Practice Address - Fax:912-823-4232
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW 0031221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA312364857AMedicaid
GA10045584OtherAMERIGROUP
GA312364857BMedicaid
GA312364857CMedicaid