Provider Demographics
NPI:1821214404
Name:AMY L. ALDERSON, PH.D. LLC
Entity Type:Organization
Organization Name:AMY L. ALDERSON, PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-668-1331
Mailing Address - Street 1:1071 CAMBRIDGE SQ
Mailing Address - Street 2:SUITE E
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1843
Mailing Address - Country:US
Mailing Address - Phone:404-668-1331
Mailing Address - Fax:678-393-8637
Practice Address - Street 1:1071 CAMBRIDGE SQ
Practice Address - Street 2:SUITE E
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-1843
Practice Address - Country:US
Practice Address - Phone:404-668-1331
Practice Address - Fax:678-393-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2514103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00965225BMedicaid
GA26BDKLBMedicare ID - Type Unspecified
GAP48663Medicare UPIN
GA00965225BMedicaid