Healthcare Provider Details

I. General information

NPI: 1013534403
Provider Name (Legal Business Name): JUSTICE MALEE PERRY BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 PAVILION PKWY
FAYETTEVILLE GA
30214-4056
US

IV. Provider business mailing address

680 THORNTON WAY
LITHIA SPRINGS GA
30122-2600
US

V. Phone/Fax

Practice location:
  • Phone: 770-954-8988
  • Fax: 317-520-8200
Mailing address:
  • Phone: 470-734-8251
  • Fax: 844-965-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA003236
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: