Organization
JADA TIDWELL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JADA A. TIDWELL PH.D. (OWNER)
(404) 797-0889
Entity
Organization
Contact information
Practice address
215 CHURCH ST, STE 105, DECATUR, GA 30030-4617
(404) 797-0889
(404) 378-2039
Mailing address
215 CHURCH ST, STE 105, DECATUR, GA 30030-4617
(404) 797-0889
(404) 378-2039
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
09/14/2009
Last updated
09/14/2009
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