Provider Demographics
NPI:1316159569
Name:FAIR, PAUL LAVERE (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LAVERE
Last Name:FAIR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 PIEDMONT ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1506
Mailing Address - Country:US
Mailing Address - Phone:404-233-7439
Mailing Address - Fax:
Practice Address - Street 1:3580 PIEDMONT ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1506
Practice Address - Country:US
Practice Address - Phone:404-233-7439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1055103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical