Healthcare Provider Details

I. General information

NPI: 1184842247
Provider Name (Legal Business Name): DIANA MARIE ZECKHAUSEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 POWERS FERRY RD SE BUILDING 22, STE 200
ATLANTA GA
30339-5621
US

IV. Provider business mailing address

1827 POWERS FERRY RD SE BUILDING 22, STE 200
ATLANTA GA
30339-5621
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-4744
  • Fax: 770-953-4640
Mailing address:
  • Phone: 770-953-4744
  • Fax: 770-953-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1482
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: