Individual
DR. ELLEN MARTIN LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
6030 BETHELVIEW RD STE 401, CUMMING, GA 30040-8063
(770) 889-1980
Mailing address
6030 BETHELVIEW RD STE 401, CUMMING, GA 30040-8063
(770) 889-1980
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1510
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00647919F
—
GA
Enumeration date
10/03/2006
Last updated
07/09/2007
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