MEDICARE: IVYE OWENSBY

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	106H00000X	Marriage & Family Therapist	MFT002269	GA

General Provider Information

NPI Number	:	1699624403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVYE OWENSBY

Provider Business Mailing Address
First Line	:	2613 MENDY CT
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30012-5500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 GRANT ST SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-2241
Country	:	US
Telephone Number	:	678-653-5280
Fax Number	:

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “ IVYE OWENSBY ” Practice Location

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