Healthcare Provider Details

I. General information

NPI: 1407927791
Provider Name (Legal Business Name): THOMAS EDWARD ORR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 WALTON WAY EXT
AUGUSTA GA
30909-4507
US

IV. Provider business mailing address

PO BOX 2793
AUGUSTA GA
30914-2793
US

V. Phone/Fax

Practice location:
  • Phone: 706-729-9595
  • Fax: 706-729-0332
Mailing address:
  • Phone: 706-729-9595
  • Fax: 706-729-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002133
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: