Healthcare Provider Details

I. General information

NPI: 1386912905
Provider Name (Legal Business Name): JOYCE D GEDDIE RN, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2985 CHEROKEE ST NW
KENNESAW GA
30144-2863
US

IV. Provider business mailing address

2985 CHEROKEE ST NW
KENNESAW GA
30144-2863
US

V. Phone/Fax

Practice location:
  • Phone: 770-218-9005
  • Fax:
Mailing address:
  • Phone: 770-218-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN065556
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007988
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: