Healthcare Provider Details

I. General information

NPI: 1174946842
Provider Name (Legal Business Name): ADRIAN JANIT, PHD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 EXECUTIVE CENTER DR
MARTINEZ GA
30907-2360
US

IV. Provider business mailing address

3736 EXECUTIVE CENTER DR
MARTINEZ GA
30907-2360
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-4599
  • Fax:
Mailing address:
  • Phone: 706-364-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY00347
License Number StateGA

VIII. Authorized Official

Name: DR. ADRIAN JANIT
Title or Position: OWNER
Credential: PHD
Phone: 706-364-4599