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General NPI Number Information
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NPI Number | 1245429984
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Entity Type | Organization
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Legal Business Name | SKINNER AND ASSOCIATES P.C.
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 66 FARMER ST
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City | NEWNAN
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State | GA
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Zip | 30263-1437
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Country | US
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Telephone | 770-253-3512
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Fax |
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Provider Business Mailing Address
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Address Line | 66 FARMER ST
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City | NEWNAN
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State | GA
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Zip | 30263-1437
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Country | US
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Telephone | 770-253-3512
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. WALTER WINSTON SKINNER
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Credential | EDD GA LICENSE 1295
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Telephone | 770-253-3512
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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 | 1295
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License Number State | GA
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