Healthcare Provider Details

I. General information

NPI: 1508857475
Provider Name (Legal Business Name): NICHOLAS HUME PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4994 LOWER ROSWELL RD SUITE 29
MARIETTA GA
30068-4332
US

IV. Provider business mailing address

4994 LOWER ROSWELL RD SUITE 29
MARIETTA GA
30068-4332
US

V. Phone/Fax

Practice location:
  • Phone: 770-977-2987
  • Fax: 678-236-6041
Mailing address:
  • Phone: 770-977-2987
  • Fax: 678-236-6041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number505
License Number StateGA

VIII. Authorized Official

Name: DR. NICHOLAS HUME
Title or Position: PRESIDENT
Credential: PHD
Phone: 770-977-2987