MEDICARE: JOHN CALVIN ALBERTY 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LPC003892	GA
2	101YM0800X	Mental Health Counselor	LPC003892	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPC003892	OTHER	GA	STATE LICENSE

General Provider Information

NPI Number	:	1740258771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CALVIN ALBERTY PH.D.

Provider Business Mailing Address
First Line	:	431 W 9TH ST
Second Line	:
City	:	LOUISVILLE
State	:	GA
Zip	:	30434-1481
Country	:	US
Telephone Number	:	706-790-6434
Fax Number	:

Provider Business Practice Location Address
First Line	:	3114 AUGUSTA TECH DR
Second Line	:	SUITE 203
City	:	AUGUSTA
State	:	GA
Zip	:	30906-3300
Country	:	US
Telephone Number	:	706-790-6434
Fax Number	:

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	09/11/2025

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