Healthcare Provider Details

I. General information

NPI: 1720483340
Provider Name (Legal Business Name): JESSICA HALEY GEDDES PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 WIMBLEDON RD NE
ATLANTA GA
30324-4965
US

IV. Provider business mailing address

1031 WILLIVEE DR
DECATUR GA
30033-4129
US

V. Phone/Fax

Practice location:
  • Phone: 678-743-1682
  • Fax:
Mailing address:
  • Phone: 678-743-1682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY003728
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003728
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: