MEDICARE: DIANE DOLORE SYKES PSY.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
1	103T00000X	Psychologist	PSY003667	GA

General Provider Information

NPI Number	:	1356784946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE DOLORE SYKES PSY.D.

Provider Business Mailing Address
First Line	:	3879 SPALDING WOOD DR
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30092-2602
Country	:	US
Telephone Number	:	678-691-5702
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 RESEARCH CT
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-6606
Country	:	US
Telephone Number	:	678-749-7600
Fax Number	:	770-232-9043

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2013
Last Update Date	:	04/12/2013

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