Individual
MALCOLM JAQUAN EADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6849 PEACHTREE DUNWOODY RD BLDG A1, ATLANTA, GA 30328-6769
(678) 691-2206
(404) 393-3133
Mailing address
685 ROUNTREE RD APT D26, RIVERDALE, GA 30274-3457
(404) 317-3055
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000
RBT
GA
Enumeration date
06/26/2020
Last updated
06/26/2020
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