Healthcare Provider Details

I. General information

NPI: 1548479850
Provider Name (Legal Business Name): MARTHA MERCEDES MEJIA-GORDY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 THE EXCHANGE SE STE 550
ATLANTA GA
30339-2088
US

IV. Provider business mailing address

1354 PEPPERGRASS TRAIL
ACWORTH GEORGIA
30101
UM

V. Phone/Fax

Practice location:
  • Phone: 404-713-1997
  • Fax: 404-773-2447
Mailing address:
  • Phone: 404-713-1997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002822
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number02822
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: