MEDICARE: STEVEN ALEX KONTOS III PSYD

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

General Provider Information

NPI Number	:	1568182442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN ALEX KONTOS III PSYD

Provider Business Mailing Address
First Line	:	3816 CLINE DR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-3115
Country	:	US
Telephone Number	:	205-356-1213
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1895
Country	:	US
Telephone Number	:	205-356-1213
Fax Number	:

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

Provider Enumeration Date	:	08/31/2022
Last Update Date	:	08/31/2022

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