Provider Demographics
NPI:1770864951
Name:OWENS DAY, AUDREY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:L
Last Name:OWENS DAY
Suffix:
Gender:F
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:PO BOX 6713
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-0713
Mailing Address - Country:US
Mailing Address - Phone:404-229-6701
Mailing Address - Fax:
Practice Address - Street 1:215 CHURCH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3330
Practice Address - Country:US
Practice Address - Phone:404-229-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3484103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist