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Individual

KALLIO HUNNICUTT-FERGUSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
12 EXECUTIVE PARK DR NE, ATLANTA, GA 30329-2206
(404) 778-7777
Mailing address
12 EXECUTIVE PARK DR NE, ATLANTA, GA 30329-2206
(404) 778-7777

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
PSY004124
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
021253
NEW YORK STATE EDUCATION DEPARTMENT, LICENSE IN CLINICAL PSYCHOLOGY
NY
01
94893
NEW YORK STATE EDUCATION DEPARTMENT LIMITED PERMIT FOR CLINICAL PSYCHOLOGY
NY
01
PSY004124
STATE OF GEORGIA, STATE BOARD OF EXAMINERS OF PSYCHOLOGISTS
GA
Enumeration date
01/30/2015
Last updated
07/21/2022
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