Provider Demographics
NPI:1598019994
Name:REDDING, JAMIE L (BCBA)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:L
Last Name:REDDING
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 OLDE COTTAGE LN
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-2307
Mailing Address - Country:US
Mailing Address - Phone:877-321-2899
Mailing Address - Fax:877-540-0182
Practice Address - Street 1:79 OLDE COTTAGE LN
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-2307
Practice Address - Country:US
Practice Address - Phone:877-321-2899
Practice Address - Fax:877-540-0182
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-12-5173103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003206138AMedicaid