Provider Demographics
NPI:1477311736
Name:IAMIRONPANDA
Entity Type:Organization
Organization Name:IAMIRONPANDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CLC, MB/TF-CBT
Authorized Official - Phone:404-594-0625
Mailing Address - Street 1:2479 ORTEGA WAY
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3620
Mailing Address - Country:US
Mailing Address - Phone:404-594-0625
Mailing Address - Fax:
Practice Address - Street 1:9 DUNWOODY PARK STE 136
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6796
Practice Address - Country:US
Practice Address - Phone:404-594-0625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty