Provider Demographics
NPI:1306938857
Name:ARNOLD, ANN PENNEBAKER (PHD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:PENNEBAKER
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3610 IVY RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4510
Mailing Address - Country:US
Mailing Address - Phone:404-237-5891
Mailing Address - Fax:404-262-9331
Practice Address - Street 1:8954 HOSPITAL DR
Practice Address - Street 2:SUITE B-110
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2272
Practice Address - Country:US
Practice Address - Phone:770-920-6555
Practice Address - Fax:404-262-9331
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1767103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist