| Decatur Psychology, Llc | |
|
101 Birch St Decatur GA 30030-3340 | |
| (404) 513-6077 | |
| (404) 478-6823 |
| Full Name | Decatur Psychology, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 101 Birch St, Decatur, Georgia |
| Authorized Official Name and Position | John Rackley Lucy (OWNER) |
| Authorized Official Contact | 4045136077 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Decatur Psychology, Llc 101 Birch St Decatur GA 30030-3340 Ph: (404) 513-6077 | Decatur Psychology, Llc 101 Birch St Decatur GA 30030-3340 Ph: (404) 513-6077 |
| NPI Number | 1194013912 |
|---|---|
| Provider Enumeration Date | 07/13/2011 |
| Last Update Date | 05/26/2021 |
| Certification Date | 05/26/2021 |
| Medicare PECOS PAC ID | 9032372834 |
|---|---|
| Medicare Enrollment ID | O20120515000029 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194013912 | NPI | - | NPPES |
| 1134380322 | Other | GA | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY001911 (Georgia) | Primary |
| Provider Name | John R Lucy |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134380322 PECOS PAC ID: 7012081433 Enrollment ID: I20080804000244 |
Joseph T Elder, Psy.d., P.c. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1439 Mclendon Dr Ste D, Decatur, GA 30033 Phone: 404-493-4381 Fax: 770-934-3280 | |
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