| Intown Pediatric Behavioral Wellness Llc | |
|
340 Boulevard Ne Suite 345 Atlanta GA 30312-1273 | |
| (404) 653-0322 | |
| (404) 653-0466 |
| Full Name | Intown Pediatric Behavioral Wellness Llc |
|---|---|
| Speciality | Psychologist - Clinical Child & Adolescent |
| Location | 340 Boulevard Ne, Atlanta, Georgia |
| Authorized Official Name and Position | Jennifer Lynn Poulos (OWNER/PEDIATRIC PSYCHOLOGIST) |
| Authorized Official Contact | 7706561365 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Intown Pediatric Behavioral Wellness Llc 1170 N Highland Ave Ne B10 Atlanta GA 30306-3400 Ph: (770) 656-1365 | Intown Pediatric Behavioral Wellness Llc 340 Boulevard Ne Suite 345 Atlanta GA 30312-1273 Ph: (404) 653-0322 |
| NPI Number | 1265895569 |
|---|---|
| Provider Enumeration Date | 04/04/2016 |
| Last Update Date | 04/04/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265895569 | NPI | - | NPPES |
| 003139753A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | PSY003708 (Georgia) | Primary |
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