MEDICARE: DEBRA ALVIS, PH.D., INC

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	251S00000X	Community/Behavioral Health Agency	PSY2296	GA

General Provider Information

NPI Number	:	1497902480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRA ALVIS, PH.D., INC

Provider Business Mailing Address
First Line	:	1551 JENNINGS MILL RD
Second Line	:	SUITE 2000 B
City	:	BOGART
State	:	GA
Zip	:	30622-2544
Country	:	US
Telephone Number	:	706-369-7441
Fax Number	:	706-549-2569

Provider Business Practice Location Address
First Line	:	1551 JENNINGS MILL RD
Second Line	:	SUITE 2000 B
City	:	BOGART
State	:	GA
Zip	:	30622-2544
Country	:	US
Telephone Number	:	706-369-7441
Fax Number	:	706-549-2569

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEBRA KAY ALVIS
Credential	:	PH.D.
Telephone Number	:	706-369-7441

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	08/21/2008

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