Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY003656 | GA |
N | 103T00000X | Psychologist | PSY003656 | GA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY003656 | GA |
Y | 103G00000X | Clinical Psychologist | PSY003656 | GA |
Y | 103TC0700X | Clinical Psychologist | PSY003656 | GA |
N | 103TC1900X | Counseling Psychologist | PSY003656 | GA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY003656 | GA |
N | 103TF0000X | Family Psychologist | PSY003656 | GA |
N | 103TF0200X | Forensic Psychologist | PSY003656 | GA |
NPI | 1245572437 |
---|---|
Provider Name | Jonathan Todd George |
First Address | Atlanta, GA 30341-1316 |
Second Address | Atlanta, GA 30341-1316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2013 |
Last Update Date | 26/03/2013 |