Provider Demographics
NPI:1346252418
Name:FERNHOFF, DEBORAH F (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:F
Last Name:FERNHOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 W WIEUCA RD NE
Mailing Address - Street 2:BLDG. 2 STE. 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3352
Mailing Address - Country:US
Mailing Address - Phone:404-255-7929
Mailing Address - Fax:404-303-0661
Practice Address - Street 1:300 W WIEUCA RD NE
Practice Address - Street 2:BLDG. 2 STE. 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3352
Practice Address - Country:US
Practice Address - Phone:404-255-7929
Practice Address - Fax:404-303-0661
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA442103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00189736AMedicaid
GAR81822Medicare UPIN