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General NPI Number Information
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NPI Number | 1891409074
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Entity Type | Individual
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Provider Name | JOAN WILBANKS PHD
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Gender | Female
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 2296 HENDERSON MILL RD NE
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City | ATLANTA
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State | GA
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Zip | 30345-2739
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Country | US
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Telephone | 770-492-2748
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Fax |
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Provider Business Mailing Address
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Address Line | 3998 DUNCAN IVES DR
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City | BUFORD
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State | GA
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Zip | 30519-7566
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Country | US
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Telephone |
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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 | PY11681
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License Number State | FL
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