MEDICARE: DR. MOGENS REIMER JENSEN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	001343	GA

General Provider Information

NPI Number	:	1255545851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOGENS REIMER JENSEN PH.D.

Provider Business Mailing Address
First Line	:	300 COLONIAL CENTER PKWY
Second Line	:	SUITE 100
City	:	ROSWELL
State	:	GA
Zip	:	30076-4892
Country	:	US
Telephone Number	:	770-640-1650
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 COLONIAL CENTER PKWY
Second Line	:	SUITE 100
City	:	ROSWELL
State	:	GA
Zip	:	30076-4892
Country	:	US
Telephone Number	:	770-640-1650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	03/08/2013

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