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General NPI Number Information
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NPI Number | 1497924195
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Entity Type | Individual
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Provider Name | ELLEN D SPANDORFER PSYD
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Gender | Female
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 698 N MARIETTA PKWY NE
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City | MARIETTA
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State | GA
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Zip | 30060-1529
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Country | US
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Telephone | 770-919-9088
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Fax | 770-919-8708
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Provider Business Mailing Address
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Address Line | 1902 DENTON WALK CT
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City | MARIETTA
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State | GA
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Zip | 30062-8158
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Country | US
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Telephone | 404-551-4322
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY003147
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License Number State | GA
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