Provider Demographics
NPI:1639761042
Name:JAMES, ZADIE (APC)
Entity Type:Individual
Prefix:
First Name:ZADIE
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 BOWMAN HWY NW
Mailing Address - Street 2:
Mailing Address - City:DEWY ROSE
Mailing Address - State:GA
Mailing Address - Zip Code:30634-3018
Mailing Address - Country:US
Mailing Address - Phone:478-235-2844
Mailing Address - Fax:
Practice Address - Street 1:250 BRAY ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2203
Practice Address - Country:US
Practice Address - Phone:706-389-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006451101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor