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General NPI Number Information
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NPI Number | 1851511851
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR BEHAVIORAL MEDICINE
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 696 CONCORD RD SE
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City | SMYRNA
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State | GA
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Zip | 30082-2629
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Country | US
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Telephone | 770-319-8013
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Fax | 770-319-8021
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Provider Business Mailing Address
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Address Line | 696 CONCORD RD SE
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City | SMYRNA
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State | GA
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Zip | 30082-2629
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Country | US
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Telephone | 770-319-8013
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Fax | 770-319-8021
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Authorized Official
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Title or Position | OWNER
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Name | ASHRAF ATTALLA
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Credential | MD
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Telephone | 770-319-8013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 054960
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License Number State | GA
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