Provider Demographics
NPI:1972805786
Name:ANDERSON, JILL C (PSYD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BUFORD HWY STE G7
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8727
Mailing Address - Country:US
Mailing Address - Phone:404-542-5287
Mailing Address - Fax:888-485-5215
Practice Address - Street 1:1400 BUFORD HWY STE G7
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-8727
Practice Address - Country:US
Practice Address - Phone:404-542-5287
Practice Address - Fax:888-485-5215
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical