Doctor Name: | MR. JOHN WILLIAM LANDRUM |
NPI Number: | 1619093564 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | LPC004318 |
Business Practice Address: | 107 Alex Dr Chickamauga, GA - 307074154 |
Business Phone Number: | 7065392228 |
Business Fax Number: | |
Mailing Address: | 5217 Cheryl Ln # B, CHATTANOOGA |
State: | TN |
Postal Code: | 374151833 |
Phone Number: | 4238774178 |
Fax Number: | |
NPI Enumeration Date: | 03/22/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC004318 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |