Healthcare Provider Details

I. General information

NPI: 1437647898
Provider Name (Legal Business Name): DONNA MARIE JAMES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 SUGGS ST
ROSSVILLE GA
30741-2223
US

IV. Provider business mailing address

13570 N MAIN ST
TRENTON GA
30752-2012
US

V. Phone/Fax

Practice location:
  • Phone: 706-866-5520
  • Fax: 706-866-5502
Mailing address:
  • Phone: 706-956-2665
  • Fax: 706-657-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003552
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: