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General NPI Number Information
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NPI Number | 1346546702
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Entity Type | Organization
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Legal Business Name | NICK A DEFILIPPIS, PH.D., PC
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Dates
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Enumeration Date | 02/02/2011
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Last Update Date | 02/02/2011
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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 NE 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 |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICK ANTHONY DEFILIPPIS
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Credential |
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Telephone | 770-730-9930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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