MEDICARE: DR. TORI KEARNS 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	103T00000X	Psychologist	3519	GA

General Provider Information

NPI Number	:	1952668147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TORI KEARNS PH.D.

Provider Business Mailing Address
First Line	:	112 N COLLEGE ST
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-5309
Country	:	US
Telephone Number	:	912-495-8488
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 N COLLEGE ST
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-5309
Country	:	US
Telephone Number	:	912-495-8488
Fax Number	:

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

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	05/14/2014

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