Provider Demographics
NPI:1013217124
Name:JAMES, COURTNEY LYNN ROSE (MS)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LYNN ROSE
Last Name:JAMES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:LYNN ROSE
Other - Last Name:NEWSOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:35 WESTFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016
Mailing Address - Country:US
Mailing Address - Phone:601-297-7387
Mailing Address - Fax:
Practice Address - Street 1:35 TECHNOLOGY PKWY S STE 100
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2996
Practice Address - Country:US
Practice Address - Phone:833-628-8476
Practice Address - Fax:770-200-1563
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YM0800X
GARBT-20-141298106S00000X
GA1-23-65049103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018214Medicaid