Provider Demographics
NPI:1386909208
Name:CASEY, TABITHA ROBIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:TABITHA
Middle Name:ROBIN
Last Name:CASEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:
Practice Address - Street 1:100 LAKE HEARN DRIVE, NE STE'S 250 & 500
Practice Address - Street 2:KAISER PERMANETE SANDY SPRINGS MEDICAL CENTER
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-845-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
GAPSY006314103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist