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General NPI Number Information
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NPI Number | 1730236951
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Entity Type | Individual
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Provider Name | LOUISA PORTER BRANSCOMB PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5 S PUBLIC SQ SUITE 103
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City | CARTERSVILLE
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State | GA
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Zip | 30120-3348
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Country | US
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Telephone | 678-721-0103
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Fax | 770-382-0023
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Provider Business Mailing Address
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Address Line | 150 BOWEN RD NE
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City | WHITE
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State | GA
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Zip | 30184-2026
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Country | US
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Telephone | 678-721-0103
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Fax | 770-382-0023
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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 | PSY001315
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY00002224
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License Number State | WA
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