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General NPI Number Information
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NPI Number | 1629369699
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Entity Type | Individual
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Provider Name | DOUGLAS JAY STONE-MILLER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 829 DIXIE AVE.
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City | ATLANTA
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State | GA
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Zip | 30307
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Country | US
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Telephone | 770-957-7777
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Fax | 404-658-9505
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Provider Business Mailing Address
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Address Line | 3939 JODECO RD
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City | MCDONOUGH
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State | GA
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Zip | 30253-5477
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Country | US
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Telephone | 770-957-7777
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Fax | 770-957-0957
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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 | PSY002081
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License Number State | GA
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