Healthcare Provider Details

I. General information

NPI: 1689813412
Provider Name (Legal Business Name): NORTH FULTON PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MILTON AVE SUITE 207
ALPHARETTA GA
30009-1570
US

IV. Provider business mailing address

41 MILTON AVE SUITE 207
ALPHARETTA GA
30009-1570
US

V. Phone/Fax

Practice location:
  • Phone: 770-752-8999
  • Fax: 678-277-9181
Mailing address:
  • Phone: 770-752-8999
  • Fax: 678-277-9181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY001879
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY001879
License Number StateGA

VIII. Authorized Official

Name: DR. CAROL COX PURSLEY
Title or Position: CEO
Credential: PH.D., M.S.
Phone: 770-752-8999