Provider Demographics
NPI:1457563637
Name:MILLIE C. ASTIN, PHD, PC
Entity Type:Organization
Organization Name:MILLIE C. ASTIN, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ASTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-248-1023
Mailing Address - Street 1:1790 CENTURY BLVD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3322
Mailing Address - Country:US
Mailing Address - Phone:404-248-1023
Mailing Address - Fax:
Practice Address - Street 1:1790 CENTURY BLVD.
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3322
Practice Address - Country:US
Practice Address - Phone:404-248-1023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY 002201103T00000X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty