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General NPI Number Information
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NPI Number | 1578628988
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Entity Type | Individual
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Provider Name | JAMES BERNARD KYNES SR. M. DIV.
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Gender | Male
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 209 SWANTON WAY # A
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City | DECATUR
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State | GA
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Zip | 30030-3271
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Country | US
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Telephone | 404-378-2232
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Fax | 404-378-2239
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Provider Business Mailing Address
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Address Line | PO BOX 2094
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City | DECATUR
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State | GA
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Zip | 30031-2094
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Country | US
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Telephone | 404-378-2232
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Fax | 404-378-2239
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000870
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License Number State | GA
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