Provider Demographics
NPI:1891397675
Name:MCCLAMMY, KARIS LEANNE (PSYD)
Entity Type:Individual
Prefix:
First Name:KARIS
Middle Name:LEANNE
Last Name:MCCLAMMY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 BROCKETT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7326
Mailing Address - Country:US
Mailing Address - Phone:770-375-8124
Mailing Address - Fax:770-559-5543
Practice Address - Street 1:1370 CENTER DR STE 205
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-4132
Practice Address - Country:US
Practice Address - Phone:770-375-8124
Practice Address - Fax:770-559-5543
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004441103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical