Healthcare Provider Details

I. General information

NPI: 1891618518
Provider Name (Legal Business Name): MAX SAMUEL GREYSON LCSW
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1666 CEDAR BLUFF WAY
MARIETTA GA
30062-3236
US

IV. Provider business mailing address

1666 CEDAR BLUFF WAY
MARIETTA GA
30062-3236
US

V. Phone/Fax

Practice location:
  • Phone: 770-865-8997
  • Fax:
Mailing address:
  • Phone: 770-865-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010641
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: