Healthcare Provider Details

I. General information

NPI: 1710577143
Provider Name (Legal Business Name): ALLISON JAYE SCHWARTZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 SHOUP CT
DECATUR GA
30033-4607
US

IV. Provider business mailing address

1551 SHOUP CT
DECATUR GA
30033-4607
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-8350
  • Fax: 404-727-3639
Mailing address:
  • Phone: 404-727-8350
  • Fax: 404-727-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY004462
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: