Healthcare Provider Details

I. General information

NPI: 1205290491
Provider Name (Legal Business Name): MICHELLE MARY HADDAD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CLIFTON RD NE
ATLANTA GA
30322-6560
US

IV. Provider business mailing address

1441 CLIFTON RD NE
ATLANTA GA
30322-1004
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-5667
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY004294
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY004294
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: