Provider Demographics
NPI:1255447249
Name:HIGGINS, THOMAS JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:HIGGINS
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 1:2311 BRIARLEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7005
Mailing Address - Country:US
Mailing Address - Phone:770-395-0700
Mailing Address - Fax:770-733-1154
Practice Address - Street 1:2311 BRIARLEIGH WAY
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7005
Practice Address - Country:US
Practice Address - Phone:770-395-0700
Practice Address - Fax:770-733-1154
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1009103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00434959CMedicaid
GA68BBFTCMedicare ID - Type UnspecifiedPSYCHOLOGIST
GA00434959CMedicaid