Healthcare Provider Details

I. General information

NPI: 1245537562
Provider Name (Legal Business Name): TAMARA N GODFREY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 08/13/2022
Certification Date: 08/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N MCDONOUGH ST
DECATUR GA
30030-3317
US

IV. Provider business mailing address

PO BOX 1742
DECATUR GA
30031-1742
US

V. Phone/Fax

Practice location:
  • Phone: 678-235-8767
  • Fax: 855-740-3001
Mailing address:
  • Phone: 678-235-8767
  • Fax: 855-740-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY003307
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: