Healthcare Provider Details

I. General information

NPI: 1760304562
Provider Name (Legal Business Name): JAMES GARDINER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 SPALDING DR
SANDY SPRINGS GA
30350-4201
US

IV. Provider business mailing address

1250 SPALDING DR
SANDY SPRINGS GA
30350-4201
US

V. Phone/Fax

Practice location:
  • Phone: 256-710-0011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number026699
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: