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General NPI Number Information
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NPI Number | 1073645735
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Entity Type | Organization
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Legal Business Name | DUNWOODY PSYCHOLOGICAL ASSOCIATION INC.
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11755 POINTE PL SUITE B
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City | ROSWELL
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State | GA
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Zip | 30076-4636
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Country | US
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Telephone | 770-521-8700
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Fax | 770-772-6425
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Provider Business Mailing Address
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Address Line | 150 WRIGHTS MILL PL
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City | ALPHARETTA
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State | GA
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Zip | 30022-1912
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | MR. EUGENE LUNSFORD
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Credential |
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Telephone | 770-484-7773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY002851
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License Number State | GA
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