Provider Demographics
NPI:1407862477
Name:REDD, AMY ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELIZABETH
Last Name:REDD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 WARREN ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1005
Mailing Address - Country:US
Mailing Address - Phone:404-388-0767
Mailing Address - Fax:404-880-0133
Practice Address - Street 1:317 W HILL ST
Practice Address - Street 2:SUITE 203A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4367
Practice Address - Country:US
Practice Address - Phone:404-388-0767
Practice Address - Fax:404-378-8029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002972103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA456991311AMedicaid