Provider Demographics
NPI:1437877495
Name:ANXIETY AND TRAUMA CLINIC OF ATLANTA
Entity Type:Organization
Organization Name:ANXIETY AND TRAUMA CLINIC OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ROSE MORGAN
Authorized Official - Last Name:GOODNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:386-479-2261
Mailing Address - Street 1:1030 GRANT ST SE STE 4
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-2015
Mailing Address - Country:US
Mailing Address - Phone:386-479-2261
Mailing Address - Fax:
Practice Address - Street 1:1030 GRANT ST SE STE 4
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-2015
Practice Address - Country:US
Practice Address - Phone:386-479-2261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health