Provider Demographics
NPI:1194860783
Name:MASSEY, RENELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RENELLE
Middle Name:
Last Name:MASSEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 SAUTE WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1842
Mailing Address - Country:US
Mailing Address - Phone:404-292-3400
Mailing Address - Fax:
Practice Address - Street 1:1244 CLAIRMONT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1259
Practice Address - Country:US
Practice Address - Phone:404-292-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001444103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical