Provider Demographics
NPI:1497481683
Name:BROOMFIELD, JULIANNE JONES
Entity Type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:JONES
Last Name:BROOMFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 HOFSTRA CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5614
Mailing Address - Country:US
Mailing Address - Phone:404-422-5951
Mailing Address - Fax:
Practice Address - Street 1:3708 HOFSTRA CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5614
Practice Address - Country:US
Practice Address - Phone:404-422-5951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA135925103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool