Healthcare Provider Details

I. General information

NPI: 1376573543
Provider Name (Legal Business Name): NANCY JANE GUP PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 PAYTON RD NE
ATLANTA GA
30345-2600
US

IV. Provider business mailing address

2885 PAYTON RD NE
ATLANTA GA
30345-2600
US

V. Phone/Fax

Practice location:
  • Phone: 404-634-0014
  • Fax: 404-728-0043
Mailing address:
  • Phone: 404-634-0014
  • Fax: 404-728-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2414
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberGA002414
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberGA002414
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberGA002414
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberGA002414
License Number StateGA
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberGA002414
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: