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NPI Code Detail

MEDICARE: JADA S BLANDING

MEDICARE: JADA S BLANDING
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician23-283199GA

General Provider Information

NPI Number : 1992515753
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADA S BLANDING
Provider Business Mailing Address
First Line : 2440 FAIRBURN RD SW STE 101
Second Line :
City : ATLANTA
State : GA
Zip : 30331-5253
Country : US
Telephone Number : 470-419-8442
Fax Number : 470-419-8402
Provider Business Practice Location Address
First Line : 2440 FAIRBURN RD SW STE 101
Second Line :
City : ATLANTA
State : GA
Zip : 30331-5253
Country : US
Telephone Number : 470-419-8442
Fax Number : 470-419-8402
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2025
Last Update Date : 01/13/2025

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Directions to “ JADA S BLANDING ” Practice Location

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