Healthcare Provider Details

I. General information

NPI: 1316159569
Provider Name (Legal Business Name): PAUL LAVERE FAIR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 PIEDMONT ROAD SUITE 220
ATLANTA GA
30305-1506
US

IV. Provider business mailing address

3580 PIEDMONT ROAD SUITE 220
ATLANTA GA
30305-1506
US

V. Phone/Fax

Practice location:
  • Phone: 404-233-7439
  • Fax:
Mailing address:
  • Phone: 404-233-7439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1055
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1055
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: