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General NPI Number Information
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NPI Number | 1821796814
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Entity Type | Individual
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Provider Name | JAMES AUSTIN MCKELLAR
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Gender | Male
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 667 FAIRBURN RD NW
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City | ATLANTA
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State | GA
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Zip | 30331-1423
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Country | US
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Telephone | 404-586-9595
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Fax |
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Provider Business Mailing Address
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Address Line | 5931 SEQUOIA LN
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-5577
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Country | US
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Telephone | 607-205-4841
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-233371
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License Number State | GA
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