MEDICARE: ATLAS PSYCHOLOGICAL SERVICES, LLC

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

General Provider Information

NPI Number	:	1952958522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS PSYCHOLOGICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	1100 SPRING ST NW STE 380
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-2854
Country	:	US
Telephone Number	:	404-500-9681
Fax Number	:	404-585-5680

Provider Business Practice Location Address
First Line	:	1100 SPRING ST NW STE 380
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-2854
Country	:	US
Telephone Number	:	404-500-9681
Fax Number	:	404-585-5680

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST/OWNER
Name	:	DR. SANJAY BIPIN SHAH
Credential	:	PHD, JD
Telephone Number	:	404-500-9681

Provider Enumeration Date	:	08/19/2019
Last Update Date	:	08/19/2019

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