Provider Demographics
NPI:1245012376
Name:FELLOWS, GEORGE DAVID (CADC-II)
Entity type:Individual
Prefix:PROF
First Name:GEORGE
Middle Name:DAVID
Last Name:FELLOWS
Suffix:
Gender:M
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2779 ODUM ST
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3448
Mailing Address - Country:US
Mailing Address - Phone:561-252-8277
Mailing Address - Fax:
Practice Address - Street 1:2779 ODUM ST
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3448
Practice Address - Country:US
Practice Address - Phone:561-252-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1143101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)