Provider Demographics
NPI:1720233562
Name:JAMES E. STARK, PH.D., P.C.
Entity Type:Organization
Organization Name:JAMES E. STARK, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-541-9988
Mailing Address - Street 1:1755 THE EXCHANGE SE
Mailing Address - Street 2:SUITE 375
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7400
Mailing Address - Country:US
Mailing Address - Phone:770-541-9988
Mailing Address - Fax:770-541-9977
Practice Address - Street 1:1755 THE EXCHANGE SE
Practice Address - Street 2:SUITE 375
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7400
Practice Address - Country:US
Practice Address - Phone:770-541-9988
Practice Address - Fax:770-541-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY298251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000041544AMedicaid
GA000041544AMedicaid