Healthcare Provider Details

I. General information

NPI: 1386130078
Provider Name (Legal Business Name): JAMES CABBLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WINN WAY
DECATUR GA
30030-1715
US

IV. Provider business mailing address

445 WINN WAY PO BOX 1648
DECATUR GA
30031
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-0499
  • Fax: 404-294-0793
Mailing address:
  • Phone: 404-294-3835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003650
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: