Provider Demographics
NPI:1770708539
Name:STAMM, LINDA J (PSYD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
Last Name:STAMM
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 1:3327 AYLESBURY CT NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3119
Mailing Address - Country:US
Mailing Address - Phone:770-641-9963
Mailing Address - Fax:770-641-3024
Practice Address - Street 1:3327 AYLESBURY CT NE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3119
Practice Address - Country:US
Practice Address - Phone:770-641-9963
Practice Address - Fax:770-641-3024
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY1918103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA103TPOO16XOtherPSYCHOLOGIST-THERAPY