Healthcare Provider Details

I. General information

NPI: 1295191526
Provider Name (Legal Business Name): SYNAPSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 PIEDMONT RD NE BUILDING 11, SUITE 810
ATLANTA GA
30305-1717
US

IV. Provider business mailing address

3495 PIEDMONT RD NE BUILDING 11, SUITE 810
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 404-848-9333
  • Fax: 404-848-9334
Mailing address:
  • Phone: 404-848-9333
  • Fax: 404-848-9334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY001280
License Number StateGA

VIII. Authorized Official

Name: DR. JANET COX
Title or Position: CEO
Credential: PHD
Phone: 404-848-9333