MEDICARE: BETTIE SHEPPARD BANKS PH.D., ABPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	287	GA

General Provider Information

NPI Number	:	1427171164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTIE SHEPPARD BANKS PH.D., ABPP

Provider Business Mailing Address
First Line	:	3075 HOWELL MILL RD NW
Second Line	:	UNIT 13
City	:	ATLANTA
State	:	GA
Zip	:	30327-1657
Country	:	US
Telephone Number	:	404-355-9060
Fax Number	:	404-355-9060

Provider Business Practice Location Address
First Line	:	3075 HOWELL MILL RD NW
Second Line	:	UNIT 13
City	:	ATLANTA
State	:	GA
Zip	:	30327-1657
Country	:	US
Telephone Number	:	404-355-9060
Fax Number	:	404-355-9060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	03/22/2026

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