Provider Demographics
NPI:1558554493
Name:ATLANTA ADDICTIVE DISEASE AND PSYCHIATRY MEDICINE ASSOC
Entity Type:Organization
Organization Name:ATLANTA ADDICTIVE DISEASE AND PSYCHIATRY MEDICINE ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-475-8014
Mailing Address - Street 1:5965 PARKWAY NORTH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:770-475-8014
Mailing Address - Fax:770-886-0404
Practice Address - Street 1:5965 PARKWAY NORTH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:770-475-8014
Practice Address - Fax:770-886-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0124952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty