Provider Demographics
NPI:1558074898
Name:SALADIN, JAMES COOPER
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:COOPER
Last Name:SALADIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 CEDARHURST DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-6445
Mailing Address - Country:US
Mailing Address - Phone:404-996-8404
Mailing Address - Fax:
Practice Address - Street 1:1715 FRIENDSHIP CIR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-6917
Practice Address - Country:US
Practice Address - Phone:770-240-0163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician