Healthcare Provider Details

I. General information

NPI: 1073540589
Provider Name (Legal Business Name): COLUMBUS PSYCHOLOGICAL ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 BROOKSTONE CENTRE PARKWAY
COLUMBUS GA
31904
US

IV. Provider business mailing address

2325 BROOKSTONE CENTRE PARKWAY
COLUMBUS GA
31904
US

V. Phone/Fax

Practice location:
  • Phone: 706-653-6841
  • Fax: 706-653-7843
Mailing address:
  • Phone: 706-653-6841
  • Fax: 706-653-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: JAIMELYN CONNELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-653-6841