Individual
DR. WILLIE F AUSBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
4500 HUGH HOWELL RD, SUITE 740, TUCKER, GA 30084-4723
(770) 938-4616
(770) 938-4615
Mailing address
4500 HUGH HOWELL RD, SUITE 740, TUCKER, GA 30084-4723
(770) 938-4616
(770) 938-4615
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2449
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000885629A
CENPATICO
GA
05
—
000885629A
—
GA
01
—
001346
BLUECROSS BLUESHIELD
GA
01
—
01000298
AMERIGROUP
GA
01
—
33-1078488
NORTHLAKE MEDICAL RESEARC
GA
01
—
A3022
KAISER
GA
Enumeration date
01/22/2007
Last updated
09/02/2009
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