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General NPI Number Information
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NPI Number | 1265390975
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Entity Type | Individual
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Provider Name | CLIFFORD DAVID HACKETT PSYD
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Gender | Male
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 2805 PEACHTREE INDUSTRIAL BLVD STE 115
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City | DULUTH
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State | GA
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Zip | 30097-8170
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Country | US
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Telephone | 860-881-4592
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Fax | 470-292-3708
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Provider Business Mailing Address
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Address Line | 2805 PEACHTREE INDUSTRIAL BLVD STE 115
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City | DULUTH
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State | GA
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Zip | 30097-8170
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Country | US
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Telephone | 860-881-4592
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Fax | 470-292-3708
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 004232
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License Number State | GA
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