Healthcare Provider Details

I. General information

NPI: 1639286198
Provider Name (Legal Business Name): JONI E PRINCE PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6065 ROSWELL RD STE 515
ATLANTA GA
30328-4015
US

IV. Provider business mailing address

1185 HIGHTOWER TRL UNIT 500356
ATLANTA GA
31150-3106
US

V. Phone/Fax

Practice location:
  • Phone: 404-461-9067
  • Fax: 404-461-9067
Mailing address:
  • Phone: 404-735-4935
  • Fax: 404-735-4935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1723
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JONI E PRINCE
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 404-461-9067