Provider Demographics
NPI:1831317981
Name:TERRELL, CHARLES JEFFREY (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JEFFREY
Last Name:TERRELL
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 1:2055 MOUNT PARAN RD NW
Mailing Address - Street 2:MCCARTY BUILDING
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2921
Mailing Address - Country:US
Mailing Address - Phone:404-233-3949
Mailing Address - Fax:404-239-9460
Practice Address - Street 1:2055 MOUNT PARAN RD NW
Practice Address - Street 2:MCCARTY BUILDING
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2921
Practice Address - Country:US
Practice Address - Phone:404-233-3949
Practice Address - Fax:404-239-9460
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2025103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist