Healthcare Provider Details

I. General information

NPI: 1851626105
Provider Name (Legal Business Name): ASHLEY N. PETTONI, PSY.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 HUNTINGTON RD 201
ATHENS GA
30606-1861
US

IV. Provider business mailing address

2625 PIEDMONT RD NE 56-298
ATLANTA GA
30324-3086
US

V. Phone/Fax

Practice location:
  • Phone: 706-546-8440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003250
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY003250
License Number StateGA

VIII. Authorized Official

Name: DR. ASHLEY N PETTONI
Title or Position: PSYCHOLOGIST
Credential: PSY. D
Phone: 404-550-0388