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General NPI Number Information
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NPI Number | 1295108884
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Entity Type | Organization
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Legal Business Name | INDEPENDENT NEUROPSYCHOLOGY CONSULTANTS, LLC
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 5887 GLENRIDGE DR SUITE 140
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City | ATLANTA
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State | GA
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Zip | 30328-5574
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Country | US
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Telephone | 404-937-3107
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Fax |
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Provider Business Mailing Address
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Address Line | 2361 STREET DEVILLE NE
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City | ATLANTA
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State | GA
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Zip | 30345-3401
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Country | US
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Telephone | 404-937-3107
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Fax |
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | DR. MARLA SHAPIRO
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Credential | PH.D.
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Telephone | 404-937-3107
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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 | PSY001981
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License Number State | GA
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