MEDICARE: VONETTA MICHELLE DOTSON 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	103G00000X	Clinical Neuropsychologist	PSY10001317	MA
2	103T00000X	Psychologist	PSY10001317	MA
3	103G00000X	Clinical Neuropsychologist	PSY004288	GA

General Provider Information

NPI Number	:	1912203076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VONETTA MICHELLE DOTSON PHD

Provider Business Mailing Address
First Line	:	2752 E PONCE DE LEON AVE STE G
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-2714
Country	:	US
Telephone Number	:	404-482-3898
Fax Number	:	404-348-2359

Provider Business Practice Location Address
First Line	:	2752 E PONCE DE LEON AVE STE G
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-2714
Country	:	US
Telephone Number	:	404-482-3898
Fax Number	:

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

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	04/16/2026

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