MEDICARE: DR. JILL C ANDERSON PSYD

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	PSY003030	GA

General Provider Information

NPI Number	:	1972805786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL C ANDERSON PSYD

Provider Business Mailing Address
First Line	:	1400 BUFORD HWY STE G7
Second Line	:
City	:	SUGAR HILL
State	:	GA
Zip	:	30518-8727
Country	:	US
Telephone Number	:	404-542-5287
Fax Number	:	888-485-5215

Provider Business Practice Location Address
First Line	:	1400 BUFORD HWY STE G7
Second Line	:
City	:	SUGAR HILL
State	:	GA
Zip	:	30518-8727
Country	:	US
Telephone Number	:	404-542-5287
Fax Number	:	888-485-5215

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

Provider Enumeration Date	:	11/30/2010
Last Update Date	:	08/16/2022

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