Healthcare Provider Details

I. General information

NPI: 1972748937
Provider Name (Legal Business Name): CANDACE ADAIR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 02/16/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E PACES FERRY RD NE STE 334
ATLANTA GA
30305-3320
US

IV. Provider business mailing address

455 E PACES FERRY RD NE STE 334
ATLANTA GA
30305-3320
US

V. Phone/Fax

Practice location:
  • Phone: 404-343-3870
  • Fax:
Mailing address:
  • Phone: 404-343-3870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number65921
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number65921
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: