MEDICARE: DR. J MICHAEL ATWATER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY0003419	FL

General Provider Information

NPI Number	:	1861475881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. J MICHAEL ATWATER PH.D.

Provider Business Mailing Address
First Line	:	4362 NORTHLAKE BLVD
Second Line	:	SUITE 108
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6275
Country	:	US
Telephone Number	:	561-694-1887
Fax Number	:	561-626-2131

Provider Business Practice Location Address
First Line	:	4362 NORTHLAKE BLVD
Second Line	:	SUITE 108
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6275
Country	:	US
Telephone Number	:	561-694-1887
Fax Number	:	561-626-2131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	07/31/2020

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