Healthcare Provider Details

I. General information

NPI: 1558554493
Provider Name (Legal Business Name): ATLANTA ADDICTIVE DISEASE AND PSYCHIATRY MEDICINE ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 PARKWAY NORTH BLVD SUITE C
CUMMING GA
30040
US

IV. Provider business mailing address

5965 PARKWAY NORTH BLVD SUITE C
CUMMING GA
30040
US

V. Phone/Fax

Practice location:
  • Phone: 770-475-8014
  • Fax: 770-886-0404
Mailing address:
  • Phone: 770-475-8014
  • Fax: 770-886-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number012495
License Number StateGA

VIII. Authorized Official

Name: BARRY N JONES
Title or Position: MD OWNER
Credential: MD
Phone: 770-475-8014