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General NPI Number Information
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NPI Number | 1932273786
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Entity Type | Individual
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Provider Name | JACQUELINE MOYERMAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 210 HANNAHS MILL RD
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City | THOMASTON
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State | GA
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Zip | 30286-2801
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Country | US
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Telephone | 706-646-4543
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Fax |
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Provider Business Mailing Address
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Address Line | 6326 CAPE COD DR
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City | COLUMBUS
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State | GA
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Zip | 31904-2916
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Country | US
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Telephone | 706-570-1629
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1583
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License Number State | GA
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