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NPI Code Detail

MEDICARE: DR. DONIELLE FAGAN PH.D.

MEDICARE: DR. DONIELLE FAGAN 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
1103T00000XPsychologist

General Provider Information

NPI Number : 1578403713
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DONIELLE FAGAN PH.D.
Provider Business Mailing Address
First Line : 199 ARMOUR DR NE STE E
Second Line :
City : ATLANTA
State : GA
Zip : 30324-3975
Country : US
Telephone Number : 678-827-6658
Fax Number :
Provider Business Practice Location Address
First Line : 199 ARMOUR DR NE STE E
Second Line :
City : ATLANTA
State : GA
Zip : 30324-3975
Country : US
Telephone Number : 678-827-6658
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2026
Last Update Date : 03/30/2026

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Directions to “ DR. DONIELLE FAGAN PH.D.” Practice Location

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