Provider Demographics
NPI:1487809687
Name:LOWRANCE, JOE WALLACE JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:WALLACE
Last Name:LOWRANCE
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 NOBLE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3139
Mailing Address - Country:US
Mailing Address - Phone:404-663-8383
Mailing Address - Fax:
Practice Address - Street 1:1904 MONROE DR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4858
Practice Address - Country:US
Practice Address - Phone:404-663-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002861103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist