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General NPI Number Information
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NPI Number | 1902109200
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Entity Type | Organization
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Legal Business Name | CHARLES NORD, PH.D., P.C.
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 2150 PEACHFORD RD STE E
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City | ATLANTA
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State | GA
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Zip | 30338-6521
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Country | US
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Telephone | 770-457-2759
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Fax | 770-483-5456
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Provider Business Mailing Address
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Address Line | 2150 PEACHFORD RD STE E
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City | ATLANTA
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State | GA
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Zip | 30338-6521
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Country | US
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Telephone | 770-457-2759
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Fax | 770-483-5456
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. CHARLES NORD
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Credential | PH.D.
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Telephone | 770-457-2759
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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 | 749
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License Number State | GA
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