Provider Demographics
NPI:1326102658
Name:SNOW, JAMES STEVEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEVEN
Last Name:SNOW
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 1:655 SEMINOLE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1464
Mailing Address - Country:US
Mailing Address - Phone:404-872-5871
Mailing Address - Fax:
Practice Address - Street 1:655 SEMINOLE AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-4683
Practice Address - Country:US
Practice Address - Phone:404-872-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3102103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000723Medicaid
NC6000723Medicaid