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NPI Code Detail

MEDICARE: DR. KRISTEN J AYCOCK PH.D.

MEDICARE: DR. KRISTEN J AYCOCK 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
1103T00000XPsychologistPSY003590GA

General Provider Information

NPI Number : 1952659641
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTEN J AYCOCK PH.D.
Provider Business Mailing Address
First Line : 115 HABERSHAM DR.
Second Line :
City : FAYETTEVILLE
State : GA
Zip : 30214
Country : US
Telephone Number : 770-461-9944
Fax Number :
Provider Business Practice Location Address
First Line : 115 HABERSHAM DR
Second Line :
City : FAYETTEVILLE
State : GA
Zip : 30214-7353
Country : US
Telephone Number : 770-461-9944
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2012
Last Update Date : 01/31/2013

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