| Logsdon Conradsen, Llc | |
|
515 E Crossville Rd Suite 410 Roswell GA 30075-3087 | |
| (770) 642-7155 | |
| (770) 642-7158 |
| Full Name | Logsdon Conradsen, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 515 E Crossville Rd, Roswell, Georgia |
| Authorized Official Name and Position | Damond Logsdon-conradsen (PRESIDENT) |
| Authorized Official Contact | 7706427155 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Logsdon Conradsen, Llc 515 E Crossville Rd Suite 410 Roswell GA 30075-3087 Ph: (770) 642-7155 | Logsdon Conradsen, Llc 515 E Crossville Rd Suite 410 Roswell GA 30075-3087 Ph: (770) 642-7155 |
| NPI Number | 1174739155 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 07/23/2008 |
| Medicare PECOS PAC ID | 4880673003 |
|---|---|
| Medicare Enrollment ID | O20040720000232 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174739155 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 2347 (Georgia) | Secondary |
| 103TC0700X | Psychologist - Clinical | 2347 (Georgia) | Primary |
| Provider Name | Damond J Logsdon-conradsen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457472359 PECOS PAC ID: 2365412244 Enrollment ID: I20040728000889 |
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