Provider Demographics
NPI:1457472359
Name:LOGSDON, DAMOND J (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAMOND
Middle Name:J
Last Name:LOGSDON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:310 HEMBREE GROVE TRCE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1283
Mailing Address - Country:US
Mailing Address - Phone:678-232-4990
Mailing Address - Fax:770-642-7158
Practice Address - Street 1:515 E CROSSVILLE RD
Practice Address - Street 2:SUITE 420
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3087
Practice Address - Country:US
Practice Address - Phone:770-642-7155
Practice Address - Fax:770-642-7158
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA2347103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS66726Medicare UPIN
GA68BBGJKMedicare PIN