Healthcare Provider Details

I. General information

NPI: 1922214154
Provider Name (Legal Business Name): JILL BARBER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 BUFORD HWY NE SUITE 401
ATLANTA GA
30324-3207
US

IV. Provider business mailing address

2255 LAVISTA WOODS DR
TUCKER GA
30084-4212
US

V. Phone/Fax

Practice location:
  • Phone: 404-630-8238
  • Fax:
Mailing address:
  • Phone: 404-630-8238
  • Fax: 404-894-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2394
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: