Healthcare Provider Details

I. General information

NPI: 1528143112
Provider Name (Legal Business Name): PAUL J ZICK MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PEACHFORD RD STE H
ATLANTA GA
30338-6539
US

IV. Provider business mailing address

2150 PEACHFORD RD STE H
ATLANTA GA
30338-6539
US

V. Phone/Fax

Practice location:
  • Phone: 770-454-1252
  • Fax: 770-454-1256
Mailing address:
  • Phone: 770-454-1252
  • Fax: 770-454-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW 002803
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: