Provider Demographics
NPI:1003040395
Name:JOSEPH T ELDER, PSY.D., P.C.
Entity type:Organization
Organization Name:JOSEPH T ELDER, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:404-493-4381
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30085-0407
Mailing Address - Country:US
Mailing Address - Phone:404-493-4381
Mailing Address - Fax:770-934-3280
Practice Address - Street 1:1439 MCLENDON DR STE D
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1841
Practice Address - Country:US
Practice Address - Phone:404-493-4381
Practice Address - Fax:770-934-3280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002698103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGJWMedicare PIN
GAQ22703Medicare UPIN