Provider Demographics
NPI:1205011954
Name:WHIGHAM, KRISTINE BORDEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:BORDEN
Last Name:WHIGHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KRISTINE
Other - Middle Name:ANN
Other - Last Name:BORDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1001 JOHNSON FERRY RD
Mailing Address - Street 2:DEPARTMENT OF NEUROPSYCHOLOGY
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-785-2856
Mailing Address - Fax:404-785-2851
Practice Address - Street 1:5455 MERIDIAN MARK RD
Practice Address - Street 2:SUITE 180
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-785-2856
Practice Address - Fax:404-785-2851
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003130103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical