Organization
STEPHANIE L. EZUST, PH.D., PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE L. EZUST PH.D. (OWNER)
(404) 371-9171
Entity
Organization
Contact information
Practice address
1348 PONCE DE LEON AVE NE, ATLANTA, GA 30306-4604
(404) 371-9171
(404) 371-9172
Mailing address
PO BOX 1192, DECATUR, GA 30031-1192
(404) 371-9171
(404) 371-9172
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1513
GA
Other
Enumeration date
04/13/2007
Last updated
02/27/2020
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