Healthcare Provider Details

I. General information

NPI: 1174601348
Provider Name (Legal Business Name): AFFILIATED PSYCHOLOGICAL & MEDICAL CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

200 W ACADEMY NW STE 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 Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. LUANN B WOODS
Title or Position: OFFICE MANAGER
Credential:
Phone: 678-630-4963