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General NPI Number Information
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NPI Number | 1598426538
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Entity Type | Individual
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Provider Name | COURTNEY MACLIN PHD
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Gender | Female
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 562 CONCORD RD SE
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City | SMYRNA
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State | GA
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Zip | 30082-2608
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Country | US
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Telephone | 770-384-9830
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Fax |
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Provider Business Mailing Address
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Address Line | 9582 TARA BLVD
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City | JONESBORO
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State | GA
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Zip | 30236-6089
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Country | US
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Telephone |
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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 | 3777
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License Number State | TN
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