Provider Demographics
NPI:1437379104
Name:MAX, JOANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:MAX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 THE EXCHANGE SE
Mailing Address - Street 2:SUITE 327
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2016
Mailing Address - Country:US
Mailing Address - Phone:770-933-4130
Mailing Address - Fax:770-933-4135
Practice Address - Street 1:1775 THE EXCHANGE SE
Practice Address - Street 2:SUITE 327
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2016
Practice Address - Country:US
Practice Address - Phone:770-933-4130
Practice Address - Fax:770-933-4135
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA782103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR61726Medicare UPIN
GA68BBCKVMedicare ID - Type Unspecified