Organization
INTOWN PEDIATRIC BEHAVIORAL WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER LYNN POULOS PSY.D. (OWNER/PEDIATRIC PSYCHOLOGIST)
(770) 656-1365
Entity
Organization
Contact information
Practice address
340 BOULEVARD NE, SUITE 345, ATLANTA, GA 30312-1273
(404) 653-0322
(404) 653-0466
Mailing address
1170 N HIGHLAND AVE NE, B10, ATLANTA, GA 30306-3400
(770) 656-1365
(404) 653-0466
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY003708
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003139753A
—
GA
Enumeration date
04/04/2016
Last updated
04/04/2016
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