Healthcare Provider Details

I. General information

NPI: 1558945824
Provider Name (Legal Business Name): JADASHIA STEELE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 MEDICAL PARK DR
AUSTELL GA
30106-1109
US

IV. Provider business mailing address

PO BOX 2895
SMYRNA GA
30081-2895
US

V. Phone/Fax

Practice location:
  • Phone: 678-284-2825
  • Fax:
Mailing address:
  • Phone: 678-896-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA001330
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: