Provider Demographics
NPI:1154446698
Name:BIRD, WILLIAM A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:BIRD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
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Mailing Address - Street 1:11111 HOUZE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5663
Mailing Address - Country:US
Mailing Address - Phone:770-992-5100
Mailing Address - Fax:770-992-5127
Practice Address - Street 1:11111 HOUZE RD
Practice Address - Street 2:SUITE 350
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5663
Practice Address - Country:US
Practice Address - Phone:770-992-5100
Practice Address - Fax:770-992-5127
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GALPC2824101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional