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General NPI Number Information
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NPI Number | 1467508630
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Entity Type | Organization
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Legal Business Name | JOANNE GREEN, PHD, LLC
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Dates
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Enumeration Date | 01/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1760 CENTURY BLVD NE SUITE B
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City | ATLANTA
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State | GA
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Zip | 30345-3310
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Country | US
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Telephone | 404-909-9455
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Fax |
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Provider Business Mailing Address
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Address Line | 1760 CENTURY BLVD NE SUITE B
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City | ATLANTA
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State | GA
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Zip | 30345-3310
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Country | US
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Telephone | 404-909-9455
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | JOANNE GREEN
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Credential |
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Telephone | 404-909-9455
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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 | PSY001316
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License Number State | GA
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