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General NPI Number Information
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NPI Number | 1245785815
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Entity Type | Organization
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Legal Business Name | DR. GEORGE EMANOILIDIS EPIC SERVICES PA
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 21 RYANT BLVD SUITE 21
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City | SEBRING
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State | FL
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Zip | 33870-8075
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Country | US
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Telephone | 863-243-3198
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Fax |
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Provider Business Mailing Address
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Address Line | 21 RYANT BLVD SUITE 21
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City | SEBRING
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State | FL
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Zip | 33870-8075
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Country | US
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Telephone | 863-243-3198
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED PSYCHOLOGIST
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Name | DR. GEORGE EMANOILIDIS
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Credential | PSY.D.
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Telephone | 863-243-3198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | PY8561
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY8561
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License Number State | FL
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