Provider Demographics
NPI:1770361156
Name:MCADOO, NELSONYA C (M ED)
Entity type:Individual
Prefix:
First Name:NELSONYA
Middle Name:C
Last Name:MCADOO
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 BATTLE WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3269
Mailing Address - Country:US
Mailing Address - Phone:404-403-5021
Mailing Address - Fax:
Practice Address - Street 1:7717 BATTLE WAY
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-3269
Practice Address - Country:US
Practice Address - Phone:404-403-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 171M00000X
GA466388101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty