Basic Information
| Provider Information | |||||||||
| NPI: | 1952358582 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1841 CLIFTON RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303294021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047284936 | ||||||||
| FaxNumber: | 4047286685 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 EXECUTIVE PARK DR NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303292206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047783444 | ||||||||
| FaxNumber: | 4047120278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 02/22/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 041863 | GA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 000707484C | 05 | GA | MEDICAID |