Healthcare Provider Details

I. General information

NPI: 1578858023
Provider Name (Legal Business Name): JORDAN E CATTIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 EXECUTIVE PARK DR NE
ATLANTA GA
30329-2206
US

IV. Provider business mailing address

THE EMORY CLINIC PO BOX 102632
ATLANTA GA
30368-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004018
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: