Provider Demographics
NPI:1841726304
Name:HUMPHRIES, JOSEPH RYAN
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RYAN
Last Name:HUMPHRIES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 OAK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-3907
Mailing Address - Country:US
Mailing Address - Phone:205-835-2063
Mailing Address - Fax:
Practice Address - Street 1:4196 OAK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-3907
Practice Address - Country:US
Practice Address - Phone:205-835-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GA012298101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health