Provider Demographics
NPI:1962645796
Name:PREMIER PSYCHOLOGICAL CENTER, INC.
Entity Type:Organization
Organization Name:PREMIER PSYCHOLOGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:770-603-3400
Mailing Address - Street 1:2268 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2528
Mailing Address - Country:US
Mailing Address - Phone:770-603-3400
Mailing Address - Fax:770-603-3404
Practice Address - Street 1:2268 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2528
Practice Address - Country:US
Practice Address - Phone:770-603-3400
Practice Address - Fax:770-603-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002435103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000884078BMedicaid
GA000900589DMedicaid
GA824394587AMedicaid