Provider Demographics
NPI:1902309206
Name:JAMES, LADINEA
Entity Type:Individual
Prefix:
First Name:LADINEA
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 LENOX RD NE APT D409
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-2662
Mailing Address - Country:US
Mailing Address - Phone:470-232-3806
Mailing Address - Fax:
Practice Address - Street 1:3200 LENOX RD NE APT D409
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-2662
Practice Address - Country:US
Practice Address - Phone:470-232-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$Medicaid