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General NPI Number Information
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NPI Number | 1235306663
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Entity Type | Organization
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Legal Business Name | NEWNAN PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 45B SUTHERLAND DR
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City | NEWNAN
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State | GA
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Zip | 30263-1455
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Country | US
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Telephone | 770-683-3512
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Fax | 770-683-3513
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Provider Business Mailing Address
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Address Line | 45B SUTHERLAND DR
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City | NEWNAN
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State | GA
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Zip | 30263-1455
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Country | US
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Telephone | 770-683-3512
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Fax | 770-683-3513
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Authorized Official
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Title or Position | CEO/PSYCHOLOGIST
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Name | DR. TONY ALAN JOHNSON
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Credential | PH.D.
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Telephone | 770-683-3512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1788
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License Number State | GA
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