Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY001056 | GA |
N | 103T00000X | Psychologist | PSY001056 | GA |
N | 103G00000X | Clinical Psychologist | PSY001056 | GA |
N | 103TC0700X | Clinical Psychologist | PSY001056 | GA |
N | 103TH0100X | Health Service | PSY001056 | GA |
N | 103TP2701X | Group Psychotherapist | PSY001056 | GA |
NPI | 1285789222 |
---|---|
Provider Name | Dr. Joseph Henry Fallon JR. |
First Address | Lawrenceville, GA 30043-5649 |
Second Address | Lawrenceville, GA 30043-5649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |