Healthcare Provider Details

I. General information

NPI: 1902958341
Provider Name (Legal Business Name): PSYCHOTHERAPY AND ASSESSMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 DAWSONVILLE HWY SUITE 2201
GAINESVILLE GA
30501-2610
US

IV. Provider business mailing address

629 DAWSONVILLE HWY SUITE 2201
GAINESVILLE GA
30501-2610
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-9100
  • Fax: 770-534-9104
Mailing address:
  • Phone: 770-534-9100
  • Fax: 770-534-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1575
License Number StateGA

VIII. Authorized Official

Name: DR. AMY TODD DAVIS
Title or Position: PRESIDENT
Credential: PH. D
Phone: 770-534-9100