Healthcare Provider Details

I. General information

NPI: 1801145354
Provider Name (Legal Business Name): RICHARD M ANDERSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WINDSOR ON THE MARSH
SAVANNAH GA
31419-2409
US

IV. Provider business mailing address

21 WINDSOR ON THE MARSH
SAVANNAH GA
31419-2409
US

V. Phone/Fax

Practice location:
  • Phone: 912-921-0464
  • Fax: 912-921-0464
Mailing address:
  • Phone: 912-921-0464
  • Fax: 912-921-0464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY000533
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: