Healthcare Provider Details

I. General information

NPI: 1760614119
Provider Name (Legal Business Name): PCAP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HAWTHORNE PARK STE A
ATHENS GA
30606-2164
US

IV. Provider business mailing address

215 HAWTHORNE PARK STE A
ATHENS GA
30606-2164
US

V. Phone/Fax

Practice location:
  • Phone: 706-546-9880
  • Fax:
Mailing address:
  • Phone: 706-546-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number821
License Number StateGA

VIII. Authorized Official

Name: PAUL CARDOZO
Title or Position: PRESIDENT
Credential: ED.D.
Phone: 706-546-9880