Provider Demographics
NPI:1083989479
Name:F. RICHARD BLUE PHD
Entity Type:Organization
Organization Name:F. RICHARD BLUE PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:F. RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-705-9770
Mailing Address - Street 1:6100 LAKE FORREST DR NW STE 510
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3837
Mailing Address - Country:US
Mailing Address - Phone:404-705-9770
Mailing Address - Fax:404-531-0517
Practice Address - Street 1:6100 LAKE FORREST DR NW STE 510
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3837
Practice Address - Country:US
Practice Address - Phone:404-705-9770
Practice Address - Fax:404-531-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA515103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00480191BMedicaid
GA00480191BMedicaid