Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY002399 | GA |
Y | 103T00000X | Psychologist | PSY002399 | GA |
NPI | 1003822073 |
---|---|
Provider Name | Dr. Jeffrey John Pipe |
First Address | Marietta, GA 30060-8637 |
Second Address | Marietta, GA 30060-8637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |