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General NPI Number Information
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NPI Number | 1659589349
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Entity Type | Individual
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Provider Name | HAROLD DAVID QUILLIAN PSY. D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1175 CANTON ST SUITE TWO
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City | ROSWELL
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State | GA
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Zip | 30075-3616
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Country | US
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Telephone | 770-594-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 400 LA VIEW CT
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City | ROSWELL
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State | GA
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Zip | 30075-4670
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Country | US
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Telephone | 770-993-9042
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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 | PSY002304
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License Number State | GA
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