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NPI Code Detail

MEDICARE: DR. CLIFFORD GUARNACCIA PH.D.

MEDICARE: DR. CLIFFORD GUARNACCIA PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY003178GA

General Provider Information

NPI Number : 1194973107
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLIFFORD GUARNACCIA PH.D.
Provider Business Mailing Address
First Line : 1788 CENTURY BLVD NE STE B
Second Line :
City : ATLANTA
State : GA
Zip : 30345-3321
Country : US
Telephone Number : 678-653-1875
Fax Number :
Provider Business Practice Location Address
First Line : 1788 CENTURY BLVD NE STE B
Second Line :
City : ATLANTA
State : GA
Zip : 30345-3321
Country : US
Telephone Number : 678-653-1875
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2008
Last Update Date : 02/13/2022

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