NPI age
19 years
Enumerated 2007-05-17
Across 1487 active psychologist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 000852277B | |
| 01 (GA) | 020657518001 | FED TAX ID |
| 01 (GA) | 52669312-001 | INS ID |
| 01 (GA) | 020657518 | FED TAX ID |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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