Provider Demographics
NPI:1558502054
Name:KIERAN, RACHEL ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ANNE
Last Name:KIERAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1788 CENTURY BLVD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3321
Mailing Address - Country:US
Mailing Address - Phone:404-695-1100
Mailing Address - Fax:
Practice Address - Street 1:1788 CENTURY BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3321
Practice Address - Country:US
Practice Address - Phone:404-695-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY 003129103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical