Provider Demographics
NPI:1235154311
Name:JAMES, GARY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:JAMES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 VININGS MILL CT SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6499
Mailing Address - Country:US
Mailing Address - Phone:470-669-1424
Mailing Address - Fax:404-400-4970
Practice Address - Street 1:400 GALLERIA PKWY SE STE 1500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5953
Practice Address - Country:US
Practice Address - Phone:470-669-1424
Practice Address - Fax:404-400-4970
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002876103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ51660Medicare UPIN