Healthcare Provider Details

I. General information

NPI: 1326643651
Provider Name (Legal Business Name): NADRAT NAHEEM NUHU PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E PONCE DE LEON AVE STE 265
DECATUR GA
30030-3452
US

IV. Provider business mailing address

1136 MASON WOODS DR NE
ATLANTA GA
30329-3804
US

V. Phone/Fax

Practice location:
  • Phone: 678-558-9428
  • Fax:
Mailing address:
  • Phone: 678-558-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY004456
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: