Healthcare Provider Details

I. General information

NPI: 1073704714
Provider Name (Legal Business Name): STELLA DEVON NELMS PH.D., ABPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD
DECATUR GA
30033-4004
US

IV. Provider business mailing address

1441 CLIFTON RD NE STE 170
ATLANTA GA
30322-1004
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax:
Mailing address:
  • Phone: 404-712-5667
  • Fax: 404-712-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY00347
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0810004105
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY00347
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: