Healthcare Provider Details

I. General information

NPI: 1265162606
Provider Name (Legal Business Name): HANNAH F ZICKGRAF PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 TULLIE RD NE
ATLANTA GA
30329-2309
US

IV. Provider business mailing address

75 S UNIVERSITY BLVD # 1032
MOBILE AL
36608-3271
US

V. Phone/Fax

Practice location:
  • Phone: 203-229-2000
  • Fax:
Mailing address:
  • Phone: 610-209-7829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2264
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: