Provider Demographics
NPI:1902109200
Name:CHARLES NORD, PH.D., P.C.
Entity Type:Organization
Organization Name:CHARLES NORD, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:NORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-457-2759
Mailing Address - Street 1:2150 PEACHFORD RD STE E
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6521
Mailing Address - Country:US
Mailing Address - Phone:770-457-2759
Mailing Address - Fax:770-483-5456
Practice Address - Street 1:2150 PEACHFORD RD STE E
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6521
Practice Address - Country:US
Practice Address - Phone:770-457-2759
Practice Address - Fax:770-483-5456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty