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General NPI Number Information
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NPI Number | 1790865319
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Entity Type | Organization
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Legal Business Name | REN MASSEY, PH.D., INC.
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 1244 CLAIRMONT RD SUITE 101
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City | DECATUR
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State | GA
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Zip | 30030-1250
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Country | US
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Telephone | 404-292-3400
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Fax | 404-292-3444
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Provider Business Mailing Address
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Address Line | 3206 SAUTE WAY
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City | DECATUR
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State | GA
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Zip | 30032-1842
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Country | US
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Telephone | 404-292-3400
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Fax | 404-292-3444
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REN MASSEY
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Credential | PH.D.
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Telephone | 404-292-3400
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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 | PSY001444
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License Number State | GA
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