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General NPI Number Information
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NPI Number | 1437617651
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Entity Type | Individual
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Provider Name | JULIE GRANT M.S., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 1201 CLAIRMONT RD STE 110
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City | DECATUR
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State | GA
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Zip | 30030-1258
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Country | US
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Telephone | 404-378-0441
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Fax |
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Provider Business Mailing Address
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Address Line | 931 MONROE DR. NE, SUITE 102 #513
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City | ATLANTA
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State | GA
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Zip | 30308
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Country | US
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Telephone | 770-500-8020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PSY004281
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License Number State | GA
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