Healthcare Provider Details

I. General information

NPI: 1700134277
Provider Name (Legal Business Name): ASSOCIATED HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 LONGVIEW PLZ
ST SIMONS ISLAND GA
31522-2574
US

IV. Provider business mailing address

411 LONGVIEW PLZ
ST SIMONS ISLAND GA
31522-2574
US

V. Phone/Fax

Practice location:
  • Phone: 904-280-4491
  • Fax: 904-280-4491
Mailing address:
  • Phone: 904-280-4491
  • Fax: 904-280-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY001838
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY001838
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY001838
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY001838
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY001838
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY001838
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY001838
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY001838
License Number StateGA
# 9
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY001838
License Number StateGA
# 10
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY001838
License Number StateGA

VIII. Authorized Official

Name: RONALD R HART
Title or Position: OWNER
Credential: PHD
Phone: 904-280-4491