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General NPI Number Information
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NPI Number | 1174739155
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Entity Type | Organization
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Legal Business Name | LOGSDON CONRADSEN, LLC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 515 E CROSSVILLE RD SUITE 410
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City | ROSWELL
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State | GA
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Zip | 30075-3087
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Country | US
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Telephone | 770-642-7155
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Fax | 770-642-7158
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Provider Business Mailing Address
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Address Line | 515 E CROSSVILLE RD SUITE 410
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City | ROSWELL
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State | GA
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Zip | 30075-3087
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Country | US
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Telephone | 770-642-7155
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Fax | 770-642-7158
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAMOND LOGSDON-CONRADSEN
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Credential | PHD
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Telephone | 770-642-7155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 2347
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2347
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License Number State | GA
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