Provider Demographics
NPI:1043250830
Name:FIELDS, NAOMI S (MED)
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:S
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7193 DOUGLAS BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1540
Mailing Address - Country:US
Mailing Address - Phone:770-949-0074
Mailing Address - Fax:770-949-1376
Practice Address - Street 1:7193 DOUGLAS BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1540
Practice Address - Country:US
Practice Address - Phone:770-949-0074
Practice Address - Fax:770-949-1376
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002349101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional