Provider Demographics
NPI:1861413494
Name:PATE, JOSEPH T JR (PHD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:PATE
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7214
Mailing Address - Country:US
Mailing Address - Phone:770-506-8187
Mailing Address - Fax:770-506-7436
Practice Address - Street 1:240 CORPORATE CENTER DR
Practice Address - Street 2:SUITE D
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7214
Practice Address - Country:US
Practice Address - Phone:770-506-8187
Practice Address - Fax:770-506-7436
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2391103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00856292BMedicaid