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General NPI Number Information
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NPI Number | 1710045919
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Entity Type | Organization
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Legal Business Name | EXPANSIONS INC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1447 PEACHTREE ST NE SUITE 410
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City | ATLANTA
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State | GA
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Zip | 30309-3001
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Country | US
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Telephone | 404-892-0952
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Fax |
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Provider Business Mailing Address
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Address Line | 1447 PEACHTREE ST NE SUITE 410
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City | ATLANTA
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State | GA
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Zip | 30309-3001
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Country | US
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Telephone | 404-892-0952
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERRY H DAVIS
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Credential | PHD
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Telephone | 404-892-0952
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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 | 000487
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License Number State | GA
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