Healthcare Provider Details

I. General information

NPI: 1215548094
Provider Name (Legal Business Name): JESSICA KIRKLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 09/29/2026
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 DOVE VALLEY RD
DECATUR GA
30032-2322
US

IV. Provider business mailing address

1106 DOVE VALLEY RD
DECATUR GA
30032-2322
US

V. Phone/Fax

Practice location:
  • Phone: 404-707-7982
  • Fax:
Mailing address:
  • Phone: 404-707-7982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: