Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | PSY001400 | GA |
N | 102L00000X | Psychologist | PSY001400 | GA |
N | 103T00000X | Psychologist | PSY001400 | GA |
Y | 103G00000X | Clinical Psychologist | PSY001400 | GA |
Y | 103TC0700X | Clinical Psychologist | PSY001400 | GA |
NPI | 1336116375 |
---|---|
Provider Name | Dr. Bruce E Atkinson |
First Address | Powder Springs, GA 30127-7524 |
Second Address | Atlanta, GA 30339-7407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 17/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00545069B | (05) | GA |
40055 | NATIONAL REGISTER (01) |