=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508965500
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN WILLIAM ALBRECHT PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 10/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 W HOSPITAL RD OUTPATIENT BEHAVIORAL HEALTH
-----------------------------------------------------
City | FORT GORDON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30905-5741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-787-6377
-----------------------------------------------------
Fax | 706-787-1458
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1173 SUMTER LANDING CIR
-----------------------------------------------------
City | EVANS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30809-5501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-787-6377
-----------------------------------------------------
Fax | 706-787-1458
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 01854
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------