Healthcare Provider Details

I. General information

NPI: 1114157922
Provider Name (Legal Business Name): SAORI MARUYAMA, PH.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 MEDLOCK BRIDGE RD BUILDING 300, SUITE 315
JOHNS CREEK GA
30097-4433
US

IV. Provider business mailing address

10475 MEDLOCK BRIDGE RD BUILDING 300, SUITE 315
JOHNS CREEK GA
30097-4433
US

V. Phone/Fax

Practice location:
  • Phone: 678-935-9567
  • Fax: 678-935-9568
Mailing address:
  • Phone: 678-935-9567
  • Fax: 678-935-9568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003255
License Number StateGA

VIII. Authorized Official

Name: SAORI MARUYAMA
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 678-935-9567