Provider Demographics
NPI:1376644310
Name:HIGDON, ALEX (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:HIGDON
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 1:1660 WOODWALK STRM SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-8476
Mailing Address - Country:US
Mailing Address - Phone:678-595-2244
Mailing Address - Fax:770-690-9049
Practice Address - Street 1:1660 WOODWALK STRM SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-8476
Practice Address - Country:US
Practice Address - Phone:678-595-2244
Practice Address - Fax:770-690-9049
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002599103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical