Provider Demographics
NPI:1376892703
Name:JO D FADDIS INC
Entity Type:Organization
Organization Name:JO D FADDIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JO
Authorized Official - Middle Name:D
Authorized Official - Last Name:FADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:404-325-0738
Mailing Address - Street 1:2310 BRIARCLIFF RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2802
Mailing Address - Country:US
Mailing Address - Phone:404-325-0738
Mailing Address - Fax:
Practice Address - Street 1:2310 BRIARCLIFF RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2802
Practice Address - Country:US
Practice Address - Phone:404-325-0738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty