Healthcare Provider Details

I. General information

NPI: 1609201359
Provider Name (Legal Business Name): ANNEMARIE JEFFRIES PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 02/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 CLAIRMONT RD SUITE 108
DECATUR GA
30033-4639
US

IV. Provider business mailing address

1549 CLAIRMONT RD SUITE 108
DECATUR GA
30033-4639
US

V. Phone/Fax

Practice location:
  • Phone: 404-620-3149
  • Fax:
Mailing address:
  • Phone: 404-620-3149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY003702
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY003702
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003702
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY003702
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY003702
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY003702
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY003702
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: