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General NPI Number Information
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NPI Number | 1043357874
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Entity Type | Organization
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Legal Business Name | A. SHAYNE ABELKOP PH.D. PC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 1551 JENNINGS MILL RD UNIT 2200A
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City | WATKINSVILLE
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State | GA
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Zip | 30677-7270
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Country | US
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Telephone | 706-431-3711
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Fax | 888-425-0590
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Provider Business Mailing Address
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Address Line | 1551 JENNINGS MILL RD UNIT 2200A
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City | WATKINSVILLE
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State | GA
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Zip | 30677-7270
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Country | US
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Telephone | 706-431-3711
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Fax | 888-425-0590
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST DIRECTOR
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Name | DR. A SHAYNE ABELKOP
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Credential | PH.D. PC
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Telephone | 706-431-3711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY#002799
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License Number State | GA
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