Healthcare Provider Details

I. General information

NPI: 1548254196
Provider Name (Legal Business Name): ADRIAN SHAYNE ABELKOP PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 JENNINGS MILL RD UNIT 2200A
WATKINSVILLE GA
30677-7270
US

IV. Provider business mailing address

1551 JENNINGS MILL RD UNIT 2200A
WATKINSVILLE GA
30677-7270
US

V. Phone/Fax

Practice location:
  • Phone: 706-431-3711
  • Fax: 888-425-0590
Mailing address:
  • Phone: 706-431-3711
  • Fax: 888-425-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2799
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPSY #2799
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: