Provider Demographics
NPI:1437367190
Name:PSYCHOLOGICAL SOLUTIONS OF ATLANTA, P.C.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SOLUTIONS OF ATLANTA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDI LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-293-1950
Mailing Address - Street 1:4045 ORCHARD RD SE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4902
Mailing Address - Country:US
Mailing Address - Phone:770-293-1950
Mailing Address - Fax:770-293-1955
Practice Address - Street 1:4045 ORCHARD RD SE
Practice Address - Street 2:SUITE 110
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4902
Practice Address - Country:US
Practice Address - Phone:770-293-1950
Practice Address - Fax:770-293-1955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002689103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGKRMedicare ID - Type Unspecified