JYDES FAMILY CLINIC LLC (NPI# 1275840944) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275840944 |
| Entity Type | Organization |
| Organization Name | JYDES FAMILY CLINIC LLC |
| Practice Address |
4720 Peachtree Industrial Blvd Suite 4101 Norcross GA 30071-5735 |
| Mailing Address |
5805 State Bridge Rd Suite G-106 Johns Creek GA 30097-8220 |
| Practice Telephone | 7706863232 |
| Practice Fax Number | 7706863233 |
| Mailing Telephone | 7709034665 |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2014-12-15 |
| Authorized Official Name | HAOLAT ABIOLA BABALAKIN (CEO/OWNER) |
| Authorized Official Telephone | 6784667342 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | MEDICARE PTAN | 202G263383 | 01 |
| Street Address |
4720 PEACHTREE INDUSTRIAL BLVD SUITE 4101 |
| City | NORCROSS |
| State | GA |
| Zip Code | 30071-5735 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457344186 | Justin Chang | Optometrist | 4720 Peachtree Industrial Blvd, Ste 206, Norcross, GA 30071-5735 | 2005-08-29 |
| 1447613351 | Tricia Strickland | Nurse Practitioner | 4720 Peachtree Industrial Blvd, Suite 4102, Norcross, GA 30071-5735 | 2016-03-30 |
| 1194061770 | Tia L Thomas | Social Worker | 4720 Peachtree Industrial Blvd, Suite 4101, Norcross, GA 30071-5735 | 2012-12-30 |
| 1396099578 | Northeast Family Practice P.c | Clinic/Center | 4720 Peachtree Industrial Blvd, Ste 202, Norcross, GA 30071-5735 | 2012-11-09 |
| 1255610788 | Lisa Beth Mcdaniel | Counselor | 4720 Peachtree Industrial Blvd, Suite 4101, Norcross, GA 30071-5735 | 2011-08-15 |
| 1689973919 | Michelle Lawrimore Gillespie | Counselor | 4720 Peachtree Industrial Blvd, Suite 4101, Norcross, GA 30071-5735 | 2011-03-25 |
| 1205159563 | Jjw Chiropractic Wellness Center Inc. | Chiropractor | 4720 Peachtree Industrial Blvd, Suite 4102, Norcross, GA 30071-5735 | 2010-03-01 |
| 1699098947 | Jinyoung Shin | Chiropractor | 4720 Peachtree Industrial Blvd, Suite-4102, Norcross, GA 30071-5735 | 2010-03-01 |
| 1851556997 | Justin Chang, P.C. | Optometrist | 4720 Peachtree Industrial Blvd, Ste 206, Norcross, GA 30071-5735 | 2008-07-28 |
| 1215196522 | Tuan Minh-quoc Nguyen, LLC | Specialist | 4720 Peachtree Industrial Blvd, Suite 202a, Norcross, GA 30071-1547 | 2008-06-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477199867 | 1st Senior Cares, LLC | Home Health | 7116 Peachtree Industrial Blvd. Bldg. 4, Ste. B, Peachtree Corners, GA 30071 | 2019-11-21 |
| 1124660048 | Phil Scafidi | Massage Therapist | 50 Skin Alley, Norcross, GA 30071 | 2019-10-11 |
| 1063071454 | Kenanesha Owens | Counselor | 3040 Holcolmb Bridge Rd Suite J2, Norcross, GA 30071 | 2019-06-10 |
| 1407318389 | 1st Senior Homecare, LLC | Home Health | 7116 Peachtree Industrial Blvd., Bldg 4 Suite A, Peachtree Corners, GA 30071 | 2019-04-01 |
| 1982163689 | Jk Acupuncture LLC | Acupuncturist | 5390 Peachtree Industrial Bl #101, Norcross, GA 30071 | 2019-03-13 |
| 1063990778 | First Senior Center | Clinic/Center | 7116 Peachtree Industrial Blvd, Bldg 4, Peachtree Corners, GA 30071 | 2018-08-03 |
| 1952896904 | Sonal P Patel | Physical Therapy Assistant | 4709 Peachtree Ind Blvd, Suite 106, Norcross, GA 30071 | 2018-06-22 |
| 1700392354 | Medlink Ems Inc | Ambulance | 6825 Jimmy Carter Blvd Ste 1303, Norcross, GA 30071 | 2017-12-19 |
| 1205377975 | David Kalisz II | Specialist/Technologist, Other | 1880 Beaver Ridge Circle Suite D, Norcross, GA 30071 | 2017-03-15 |
| 1356792519 | Tiffany Pope | Counselor | 6045 Atlantic Blvd Ste 108, Norcross, GA 30071 | 2016-06-28 |
| Find all providers in zip 30071 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205468840 | Angela Leigh Eubanks | Psychiatry & Neurology | 11 S Winston St, Reynolds, GA 31076-3200 | 2020-02-11 |
| 1265064364 | Haven Psychiatry, LLC | Psychiatry & Neurology | 5871 Glenridge Dr Ste 220, Atlanta, GA 30328-5305 | 2020-02-06 |
| 1760953434 | David S Deuser Md & Associates PC | Psychiatry & Neurology | 7 Saint Andrews Court, Brunswick, GA 31520 | 2018-12-06 |
| 1093249393 | Healing for All LLC | Psychiatry & Neurology | 3307 Sir Henry St, East Point, GA 30344-5831 | 2017-04-13 |
| 1699216416 | Abva, Inc | Psychiatry & Neurology | 4565 Rockmart Rd Se, Unit 1261, Silver Creek, GA 30173-2442 | 2017-03-13 |
| 1225436017 | Aatma Seva Health Inc | Psychiatry & Neurology | 523 Dixie St Ste 3, Carrollton, GA 30117-3870 | 2014-12-11 |
| 1619309309 | Howel William Slaughter Jr. | Psychiatry & Neurology | 40 Abington Ct Nw, Atlanta, GA 30327-1352 | 2013-08-05 |
| 1427493568 | Susan Kirsch | Psychiatry & Neurology | 7000 Peachtree Dunwoody Rd Bldg 16, Atlanta, GA 30328-1655 | 2013-05-02 |
| 1023362852 | Rivertown Psychiatry, PC | Psychiatry & Neurology | 1520 22nd Street, Columbus, GA 31901-1632 | 2012-10-31 |
| 1548550429 | Bene' Mental Wellness | Psychiatry & Neurology | 1835 Savoy Dr Ste 101, Atlanta, GA 30341-1073 | 2011-04-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.