Provider Demographics
NPI:1376562736
Name:BINDER, JEFFREY LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LYNN
Last Name:BINDER
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 1:4100 PACES WALK SE
Mailing Address - Street 2:1308
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-1803
Mailing Address - Country:US
Mailing Address - Phone:770-356-4805
Mailing Address - Fax:
Practice Address - Street 1:1827 POWERS FERRY RD SE
Practice Address - Street 2:BLDG. 22, STE. 200,
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5621
Practice Address - Country:US
Practice Address - Phone:770-953-4744
Practice Address - Fax:770-953-4640
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001547103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBCGXMedicare ID - Type UnspecifiedPSYCHOLOGIST PROVIDER
GAR12853Medicare UPIN