MEDICARE: JONI E PRINCE PHD PC

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	261QM0850X	Adult Mental Health Clinic/Center
2	103TC0700X	Clinical Psychologist	1723	GA

General Provider Information

NPI Number	:	1639286198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONI E PRINCE PHD PC

Provider Business Mailing Address
First Line	:	1185 HIGHTOWER TRL UNIT 500356
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31150-3106
Country	:	US
Telephone Number	:	404-735-4935
Fax Number	:	404-735-4935

Provider Business Practice Location Address
First Line	:	6065 ROSWELL RD STE 515
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4015
Country	:	US
Telephone Number	:	404-461-9067
Fax Number	:	404-461-9067

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. JONI E PRINCE
Credential	:	PHD
Telephone Number	:	404-461-9067

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	03/31/2021

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