Organization
GEORGIA AUTISM CENTER LLC
Active
Other names
JAYMIE HELEN LUCKOW FOX SOLE MBR
Organization subpart
No
Provider details
NPI number
Authorized official
JAYMIE L FOX PSY.D. (OWNER)
(770) 696-4384
Entity
Organization
Contact information
Practice address
4046 WETHERBURN WAY STE 1, PEACHTREE CORNERS, GA 30092-4614
(770) 696-4384
Mailing address
4046 WETHERBURN WAY STE 1, PEACHTREE CORNERS, GA 30092-4614
(770) 696-4384
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY2999
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
380415072C
—
GA
Enumeration date
12/19/2017
Last updated
12/19/2017
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