Provider Demographics
NPI:1316198476
Name:COURTNEY, AUDREY S (LICENSED PSYCHOLOGIS)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:S
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:LICENSED PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 MARSHALL RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-9322
Mailing Address - Country:US
Mailing Address - Phone:478-363-7927
Mailing Address - Fax:478-454-0121
Practice Address - Street 1:2930 HERITAGE PL NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7204
Practice Address - Country:US
Practice Address - Phone:478-363-7927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPSY001784OtherLICENSE NUMBER