Provider Demographics
NPI:1790268605
Name:FETNER, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FETNER
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 1:405 GLENWOOD AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3201
Mailing Address - Country:US
Mailing Address - Phone:404-578-3259
Mailing Address - Fax:
Practice Address - Street 1:3103 CLAIRMONT RD NE STE B
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1043
Practice Address - Country:US
Practice Address - Phone:770-722-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health