Provider Demographics
NPI:1073645735
Name:DUNWOODY PSYCHOLOGICAL ASSOCIATION INC.
Entity Type:Organization
Organization Name:DUNWOODY PSYCHOLOGICAL ASSOCIATION INC.
Other - Org Name:DUNWOODY PSYCHOLOGICAL ASSOCIATES LLC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-484-7773
Mailing Address - Street 1:150 WRIGHTS MILL PL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11755 POINTE PL
Practice Address - Street 2:SUITE B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4636
Practice Address - Country:US
Practice Address - Phone:770-521-8700
Practice Address - Fax:770-772-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002851103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherFEDERAL IDENTIFICATION NU