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General NPI Number Information
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NPI Number | 1447308911
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Entity Type | Organization
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Legal Business Name | GEORGIA DEVELOPMENTAL CENTER
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 615 GREEN ST NW SUITE 201
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City | GAINESVILLE
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State | GA
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Zip | 30501-3378
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Country | US
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Telephone | 770-538-4800
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Fax | 770-503-9299
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Provider Business Mailing Address
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Address Line | 615 GREEN ST NW SUITE 201
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City | GAINESVILLE
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State | GA
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Zip | 30501-3378
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Country | US
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Telephone | 770-538-4800
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Fax | 770-503-9299
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. LILLEE CLARK
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Credential | PH.D.
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Telephone | 770-538-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY001290
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License Number State | GA
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