Provider Demographics
NPI:1093075947
Name:AYNSLEY CORBETT, PSY.D. PC
Entity Type:Organization
Organization Name:AYNSLEY CORBETT, PSY.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AYNSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:404-728-0728
Mailing Address - Street 1:2004 CLIFF VALLEY WAY, NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329
Mailing Address - Country:US
Mailing Address - Phone:404-728-0728
Mailing Address - Fax:404-634-7802
Practice Address - Street 1:2004 CLIFF VALLEY WAY, NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:404-728-0728
Practice Address - Fax:404-634-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY3033103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA600531383OtherMAGELLAN
GA01243928OtherAMERIGROUP
GA717622953AMedicaid