MEDICARE: ATLANTA CENTER FOR PSYCHOTHERAPY, INC.

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	103TC0700X	Clinical Psychologist	442	GA

General Provider Information

NPI Number	:	1306959176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA CENTER FOR PSYCHOTHERAPY, INC.

Provider Business Mailing Address
First Line	:	300 W WIEUCA RD NE
Second Line	:	BLDG. 2 STE. 200
City	:	ATLANTA
State	:	GA
Zip	:	30342-3352
Country	:	US
Telephone Number	:	404-255-7929
Fax Number	:	404-303-0661

Provider Business Practice Location Address
First Line	:	300 W WIEUCA RD NE
Second Line	:	BLDG. 2 STE. 200
City	:	ATLANTA
State	:	GA
Zip	:	30342-3352
Country	:	US
Telephone Number	:	404-255-7929
Fax Number	:	404-303-0661

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. DEBORAH F. FERNHOFF
Credential	:	PH.D.
Telephone Number	:	404-255-7929

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	08/22/2020

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