Provider Demographics
NPI:1811020589
Name:BIRD LCSW, JAMES H (JAMES BIRD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:BIRD LCSW
Suffix:
Gender:M
Credentials:JAMES BIRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3086 PEACHTREE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2754
Mailing Address - Country:US
Mailing Address - Phone:404-262-1819
Mailing Address - Fax:404-262-1819
Practice Address - Street 1:3086 PEACHTREE DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2754
Practice Address - Country:US
Practice Address - Phone:404-262-1819
Practice Address - Fax:404-262-1819
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0001131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBBZTMedicare ID - Type Unspecified