Provider Demographics
NPI:1629369699
Name:STONE-MILLER, DOUGLAS JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JAY
Last Name:STONE-MILLER
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 1:3939 JODECO RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5477
Mailing Address - Country:US
Mailing Address - Phone:770-957-7777
Mailing Address - Fax:770-957-0957
Practice Address - Street 1:829 DIXIE AVE.
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307
Practice Address - Country:US
Practice Address - Phone:770-957-7777
Practice Address - Fax:404-658-9505
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002081103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical