Healthcare Provider Details

I. General information

NPI: 1396440103
Provider Name (Legal Business Name): ATLANTA PSYCHOEDUCATIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 PEACHTREE RD NE STE 1800
ATLANTA GA
30326-1064
US

IV. Provider business mailing address

2870 PEACHTREE RD NW STE 243
ATLANTA GA
30305-2918
US

V. Phone/Fax

Practice location:
  • Phone: 404-410-0224
  • Fax:
Mailing address:
  • Phone: 404-410-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DARNELL T LOGAN
Title or Position: DIRECTOR / OWNER
Credential: ED.D.
Phone: 404-410-0224