Provider Demographics
NPI:1518991967
Name:ELDER, JOSEPH T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:T
Last Name:ELDER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30085
Mailing Address - Country:US
Mailing Address - Phone:404-493-4381
Mailing Address - Fax:
Practice Address - Street 1:1439 MCLENDON DR STE D
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1841
Practice Address - Country:US
Practice Address - Phone:404-493-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002698103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist