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General NPI Number Information
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NPI Number | 1083989479
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Entity Type | Organization
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Legal Business Name | F. RICHARD BLUE PHD
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 6100 LAKE FORREST DR NW STE 510
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City | ATLANTA
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State | GA
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Zip | 30328-3837
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Country | US
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Telephone | 404-705-9770
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Fax | 404-531-0517
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Provider Business Mailing Address
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Address Line | 6100 LAKE FORREST DR NW STE 510
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City | ATLANTA
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State | GA
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Zip | 30328-3837
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Country | US
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Telephone | 404-705-9770
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Fax | 404-531-0517
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | F. RICHARD BLUE
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Credential |
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Telephone | 404-705-9770
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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 | 515
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License Number State | GA
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