Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1013505858 |
---|---|
Provider Name | Dr. Jesmond Akeem Fair |
First Address | Atlanta, GA 30311-3521 |
Second Address | Atlanta, GA 30349-5593 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2021 |
Last Update Date | 07/01/2021 |