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General NPI Number Information
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NPI Number | 1295798486
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Entity Type | Individual
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Provider Name | NICK A DEFILIPPIS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2006
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Last Update Date | 12/12/2020
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Provider Practice Location Address
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Address Line | 990 HAMMOND DR NE SUITE 730
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City | ATLANTA
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State | GA
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Zip | 30328-5529
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Country | US
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Telephone | 770-730-9930
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Fax | 770-730-0998
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Provider Business Mailing Address
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Address Line | 990 HAMMOND DR STE 575
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City | ATLANTA
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State | GA
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Zip | 30328-9113
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Country | US
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Telephone | 770-730-9930
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Fax | 770-730-0998
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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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 536
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 536
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 536
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 536
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License Number State | GA
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