| Jaymie Helen Luckow Fox Sole Mbr | |
|
4046 Wetherburn Way Ste 1 Peachtree Corners GA 30092-4614 | |
| (770) 696-4384 | |
| Not Available |
| Full Name | Jaymie Helen Luckow Fox Sole Mbr |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 4046 Wetherburn Way Ste 1, Peachtree Corners, Georgia |
| Authorized Official Name and Position | Jaymie L Fox (OWNER) |
| Authorized Official Contact | 7706964384 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jaymie Helen Luckow Fox Sole Mbr 4046 Wetherburn Way Ste 1 Peachtree Corners GA 30092-4614 Ph: (770) 696-4384 | Jaymie Helen Luckow Fox Sole Mbr 4046 Wetherburn Way Ste 1 Peachtree Corners GA 30092-4614 Ph: (770) 696-4384 |
| NPI Number | 1376059998 |
|---|---|
| Provider Enumeration Date | 12/19/2017 |
| Last Update Date | 12/19/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376059998 | NPI | - | NPPES |
| 380415072C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY2999 (Georgia) | Primary |
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