Healthcare Provider Details

I. General information

NPI: 1508601733
Provider Name (Legal Business Name): GEORGIA ASSESSMENT AND THERAPY ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W COLLEGE ST STE C
GRIFFIN GA
30224-4250
US

IV. Provider business mailing address

245 MERIWETHER ST
GRIFFIN GA
30224-3010
US

V. Phone/Fax

Practice location:
  • Phone: 470-743-8264
  • Fax: 770-228-8397
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MORGAN
Title or Position: OWNER
Credential: PHD
Phone: 470-743-8264