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General NPI Number Information
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NPI Number | 1558580571
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Entity Type | Organization
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Legal Business Name | GRISHAM ASSOCIATES, LTD.
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1180 GRIMES BRIDGE RD
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City | ROSWELL
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State | GA
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Zip | 30075-3986
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Country | US
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Telephone | 770-645-5650
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Fax |
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Provider Business Mailing Address
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Address Line | 3642 CHILDERS WAY NE
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City | ROSWELL
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State | GA
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Zip | 30075-5275
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Country | US
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Telephone | 770-645-9801
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. JOANNA W. GRISHAM
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Credential | PH.D.
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Telephone | 770-645-9801
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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 | 1449
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License Number State | GA
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