Healthcare Provider Details

I. General information

NPI: 1770735318
Provider Name (Legal Business Name): ANNA BOLLINI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD MHSL - PCMHI -5TH FLOOR
DECATUR GA
30033-4004
US

IV. Provider business mailing address

1670 CLAIRMONT RD MHSL - PCMHI -5TH FLOOR
DECATUR GA
30033-4004
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax:
Mailing address:
  • Phone: 404-321-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1396
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003019
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: