Provider Demographics
NPI:1740921071
Name:MAYS, MYESHA L
Entity type:Individual
Prefix:
First Name:MYESHA
Middle Name:L
Last Name:MAYS
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 1:166 ELMSDALE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-2299
Mailing Address - Country:US
Mailing Address - Phone:708-539-6091
Mailing Address - Fax:
Practice Address - Street 1:1619 COLLINS RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4309
Practice Address - Country:US
Practice Address - Phone:470-531-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst