Healthcare Provider Details

I. General information

NPI: 1336233774
Provider Name (Legal Business Name): ROBERT MONTES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 N POINT PKWY STE 238
ALPHARETTA GA
30022-1172
US

IV. Provider business mailing address

5755 N POINT PARKWAY SUITE 238
ALPHARETTA GA
30022
US

V. Phone/Fax

Practice location:
  • Phone: 678-366-8862
  • Fax: 678-739-0119
Mailing address:
  • Phone: 678-366-8862
  • Fax: 678-739-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 002798
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: