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General NPI Number Information
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NPI Number | 1275840944
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Entity Type | Organization
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Legal Business Name | JYDES FAMILY CLINIC LLC
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 4720 PEACHTREE INDUSTRIAL BLVD SUITE 4101
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City | NORCROSS
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State | GA
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Zip | 30071-5735
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Country | US
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Telephone | 770-686-3232
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Fax | 770-686-3233
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Provider Business Mailing Address
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Address Line | 5805 STATE BRIDGE RD STE G-106
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City | JOHNS CREEK
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State | GA
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Zip | 30097-8220
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Country | US
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Telephone | 770-903-4665
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | HAOLAT ABIOLA BABALAKIN
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Credential | M.D.
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Telephone | 678-466-7342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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