Provider Demographics
NPI:1780785832
Name:ATKINSON, JEFFREY EUGENE (LPC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EUGENE
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 SAILORS DR STE 116
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-3744
Mailing Address - Country:US
Mailing Address - Phone:678-467-7922
Mailing Address - Fax:678-406-9881
Practice Address - Street 1:64 SAILORS DR STE 116
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-3744
Practice Address - Country:US
Practice Address - Phone:678-467-7922
Practice Address - Fax:678-406-9881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC2621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA596557248AMedicaid