Provider Demographics
NPI:1366729519
Name:APPLIED PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:APPLIED PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:770-592-0150
Mailing Address - Street 1:1001 WEATHERSTONE PKWY
Mailing Address - Street 2:STE 430
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4495
Mailing Address - Country:US
Mailing Address - Phone:770-592-0150
Mailing Address - Fax:770-592-0971
Practice Address - Street 1:1001 WEATHERSTONE PKWY
Practice Address - Street 2:STE 430
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4495
Practice Address - Country:US
Practice Address - Phone:770-592-0150
Practice Address - Fax:770-592-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1754103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000583921AMedicaid