MEDICARE: BETSY A GARD PHD

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	605	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699879817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETSY A GARD PHD

Provider Business Mailing Address
First Line	:	7000 PEACHTREE DUNWOODY RD
Second Line	:	BLDG 16 S-100
City	:	ATLANTA
State	:	GA
Zip	:	30328
Country	:	US
Telephone Number	:	770-393-1880
Fax Number	:	770-393-1885

Provider Business Practice Location Address
First Line	:	7000 PEACHTREE DUNWOODY RD
Second Line	:	BLDG 16 S-100
City	:	ATLANTA
State	:	GA
Zip	:	30328
Country	:	US
Telephone Number	:	770-393-1880
Fax Number	:	770-393-1885

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

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	07/08/2007

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Directions to “ BETSY A GARD PHD” Practice Location

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