Provider Demographics
NPI:1669096145
Name:PERRY, JA'NAY AMOUR
Entity type:Individual
Prefix:
First Name:JA'NAY
Middle Name:AMOUR
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2441
Mailing Address - Country:US
Mailing Address - Phone:214-766-0460
Mailing Address - Fax:
Practice Address - Street 1:884 LEGACY PARK DR STE 302
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8760
Practice Address - Country:US
Practice Address - Phone:214-766-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
GAAPC009163101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty