Individual
MIKLE SOUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1551 SHOUP CT, DECATUR, GA 30033-4607
(404) 727-8350
Mailing address
1551 SHOUP CT, DECATUR, GA 30033-4607
(404) 727-8350
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6841090-2501
UT
Other
Enumeration date
10/02/2012
Last updated
02/21/2022
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