Provider Demographics
NPI:1033286158
Name:BEAN, PERRY J (PSYD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:J
Last Name:BEAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 HAMMOND DR NE
Mailing Address - Street 2:STE 575
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5529
Mailing Address - Country:US
Mailing Address - Phone:404-843-1612
Mailing Address - Fax:404-843-0948
Practice Address - Street 1:990 HAMMOND DR NE
Practice Address - Street 2:STE 575
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5529
Practice Address - Country:US
Practice Address - Phone:404-843-1612
Practice Address - Fax:404-843-0948
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000771103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist