Healthcare Provider Details

I. General information

NPI: 1467453795
Provider Name (Legal Business Name): PAUL ZITOWITZ ACSW LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2691 PANORAMA DR
SAUTEE NACOOCHEE GA
30571-3915
US

IV. Provider business mailing address

2691 PANORAMA DR
SAUTEE NACOOCHEE GA
30571-3915
US

V. Phone/Fax

Practice location:
  • Phone: 706-969-1017
  • Fax:
Mailing address:
  • Phone: 706-969-1017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW 5227
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003638
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: