Provider Demographics
NPI:1851278170
Name:LADER, PAUL BRIAN
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:BRIAN
Last Name:LADER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 PIERCE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2860
Mailing Address - Country:US
Mailing Address - Phone:478-475-4608
Mailing Address - Fax:478-476-8397
Practice Address - Street 1:144 PIERCE AVENUE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2860
Practice Address - Country:US
Practice Address - Phone:478-475-4608
Practice Address - Fax:478-476-8397
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty