=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720233562
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES E. STARK, PH.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2008
-----------------------------------------------------
Last Update Date | 11/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1755 THE EXCHANGE SE SUITE 375
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-7400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-541-9988
-----------------------------------------------------
Fax | 770-541-9977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1755 THE EXCHANGE SE SUITE 375
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-7400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-541-9988
-----------------------------------------------------
Fax | 770-541-9977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAMES EDWIN STARK
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 770-541-9988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | PSY298
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------