Provider Demographics
NPI:1851751580
Name:DR GJ CHILDS & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:DR GJ CHILDS & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:770-498-2865
Mailing Address - Street 1:462 WATSON BAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6198
Mailing Address - Country:US
Mailing Address - Phone:770-498-2865
Mailing Address - Fax:
Practice Address - Street 1:160 CLAIREMONT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2500
Practice Address - Country:US
Practice Address - Phone:770-498-2865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001808103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty