| James E. Stark, Ph.d., P.c. | |
|
1755 The Exchange Se Suite 375 Atlanta GA 30339-7400 | |
| (770) 541-9988 | |
| (770) 541-9977 |
| Full Name | James E. Stark, Ph.d., P.c. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1755 The Exchange Se, Atlanta, Georgia |
| Authorized Official Name and Position | James Edwin Stark (PRESIDENT) |
| Authorized Official Contact | 7705419988 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| James E. Stark, Ph.d., P.c. 1755 The Exchange Se Suite 375 Atlanta GA 30339-7400 Ph: (770) 541-9988 | James E. Stark, Ph.d., P.c. 1755 The Exchange Se Suite 375 Atlanta GA 30339-7400 Ph: (770) 541-9988 |
| NPI Number | 1720233562 |
|---|---|
| Provider Enumeration Date | 11/20/2008 |
| Last Update Date | 11/20/2008 |
| Medicare PECOS PAC ID | 8325108350 |
|---|---|
| Medicare Enrollment ID | O20081120000883 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720233562 | NPI | - | NPPES |
| 000041544A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | PSY298 (Georgia) | Primary |
| Provider Name | James E Stark |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356492037 PECOS PAC ID: 0244390276 Enrollment ID: I20081120000877 |
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