Healthcare Provider Details

I. General information

NPI: 1437097003
Provider Name (Legal Business Name): JARED KIDDOE MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 SWAN MILL CT
SUWANEE GA
30024-2819
US

IV. Provider business mailing address

1070 SWAN MILL CT
SUWANEE GA
30024-2819
US

V. Phone/Fax

Practice location:
  • Phone: 919-666-8546
  • Fax:
Mailing address:
  • Phone: 919-666-8546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JARED KIDDOE
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 919-666-8546