Organization
KEITH FALLON, PSY.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH JAMES FALLON PSY.D. (CEO)
(404) 502-5824
Entity
Organization
Contact information
Practice address
1100 GREEN ST SW, CONYERS, GA 30012-5220
(404) 502-5824
Mailing address
PO BOX 1790, CONYERS, GA 30012-7964
(404) 502-5824
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY002856
GA
Other
Enumeration date
01/16/2007
Last updated
08/22/2020
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