Provider Demographics
NPI:1093705584
Name:TOMBLIN, JAMES GARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GARY
Last Name:TOMBLIN
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 1:941 MADDOX DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EAST ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-8184
Mailing Address - Country:US
Mailing Address - Phone:706-636-3240
Mailing Address - Fax:706-636-3234
Practice Address - Street 1:941 MADDOX DR
Practice Address - Street 2:SUITE 220
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8184
Practice Address - Country:US
Practice Address - Phone:706-636-3240
Practice Address - Fax:706-636-3234
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6604101YM0800X
GALPC002329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional