MEDICARE: DR. JEFFREY LYNN BINDER 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	103TC0700X	Clinical Psychologist	PSY001547	GA

General Provider Information

NPI Number	:	1376562736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY LYNN BINDER PH.D.

Provider Business Mailing Address
First Line	:	4100 PACES WALK SE
Second Line	:	1308
City	:	ATLANTA
State	:	GA
Zip	:	30339-1803
Country	:	US
Telephone Number	:	770-356-4805
Fax Number	:

Provider Business Practice Location Address
First Line	:	1827 POWERS FERRY RD SE
Second Line	:	BLDG. 22, STE. 200,
City	:	ATLANTA
State	:	GA
Zip	:	30339-5621
Country	:	US
Telephone Number	:	770-953-4744
Fax Number	:	770-953-4640

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/09/2007

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