Provider Demographics
NPI:1073611323
Name:POLYSON, JAMES ATHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ATHAN
Last Name:POLYSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5875 BREMO RD.
Mailing Address - Street 2:SUITE 700
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1928
Mailing Address - Country:US
Mailing Address - Phone:804-741-3396
Mailing Address - Fax:804-741-3396
Practice Address - Street 1:5875 BREMO RD.
Practice Address - Street 2:SUITE 700
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1928
Practice Address - Country:US
Practice Address - Phone:804-741-3396
Practice Address - Fax:804-741-3396
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical