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General NPI Number Information
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NPI Number | 1295345734
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Entity Type | Individual
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Provider Name | JOHN MYERS
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Gender | Male
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Dates
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Enumeration Date | 08/07/2020
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 5714 OLD NATIONAL HWY
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City | COLLEGE PARK
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State | GA
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Zip | 30349-3836
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Country | US
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Telephone | 678-408-1584
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Fax |
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Provider Business Mailing Address
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Address Line | 6295 BEETHOVEN CIR
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City | RIVERDALE
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State | GA
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Zip | 30296-2301
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Country | US
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Telephone | 404-428-4082
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Fax |
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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