Provider Demographics
NPI:1639206394
Name:USSERY, DONNA RENEE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:RENEE
Last Name:USSERY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BEAVER RUIN RD NW
Mailing Address - Street 2:SUITE F
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3404
Mailing Address - Country:US
Mailing Address - Phone:770-925-7895
Mailing Address - Fax:770-925-8059
Practice Address - Street 1:700 BEAVER RUIN RD NW
Practice Address - Street 2:SUITE F
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3404
Practice Address - Country:US
Practice Address - Phone:770-925-7895
Practice Address - Fax:770-925-8059
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002709103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01000391OtherAMERIGROUP