Provider Demographics
NPI:1518158443
Name:DEFIFE, JARED A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:A
Last Name:DEFIFE
Suffix:
Gender:M
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:TUFTS HOUSE EMORY UNIVERSITY
Mailing Address - Street 2:2004 RIDGEWOOD DR.
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:TUFTS HOUSE EMORY UNIVERSITY
Practice Address - Street 2:2004 RIDGEWOOD DR.
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1031
Practice Address - Country:US
Practice Address - Phone:404-727-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003468103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical