Healthcare Provider Details

I. General information

NPI: 1386722445
Provider Name (Legal Business Name): STEPHEN P FARR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ACADEMY ST. NW SUITE A
GAINESVILLE GA
30501-8524
US

IV. Provider business mailing address

200 W. ACADEMY ST., NW SUITE A
GAINESVILLE GA
30501-8524
US

V. Phone/Fax

Practice location:
  • Phone: 770-535-1284
  • Fax: 770-536-3888
Mailing address:
  • Phone: 770-535-1284
  • Fax: 770-536-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1293
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1293
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: