Provider Demographics
NPI:1790865319
Name:REN MASSEY, PH.D., INC.
Entity Type:Organization
Organization Name:REN MASSEY, PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-292-3400
Mailing Address - Street 1:3206 SAUTE WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1842
Mailing Address - Country:US
Mailing Address - Phone:404-292-3400
Mailing Address - Fax:404-292-3444
Practice Address - Street 1:1244 CLAIRMONT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1250
Practice Address - Country:US
Practice Address - Phone:404-292-3400
Practice Address - Fax:404-292-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001444103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty