Provider Demographics
NPI:1700445475
Name:MONTFORD, JAMES OTIS JR (COUNSELOR,PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:OTIS
Last Name:MONTFORD
Suffix:JR
Gender:M
Credentials:COUNSELOR,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5357 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-5027
Mailing Address - Country:US
Mailing Address - Phone:770-942-4742
Mailing Address - Fax:770-293-0786
Practice Address - Street 1:5357 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-5027
Practice Address - Country:US
Practice Address - Phone:770-942-4742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA08189678101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional