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NPI Code Detail

MEDICARE: NORTH GEORGIA PSYCHOTHERAPY SERVICES LLC

MEDICARE: NORTH GEORGIA PSYCHOTHERAPY SERVICES LLC
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
1103T00000XPsychologist

General Provider Information

NPI Number : 1992862213
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH GEORGIA PSYCHOTHERAPY SERVICES LLC
Provider Business Mailing Address
First Line : 7450 HIGHWAY 92
Second Line : SUITE 110
City : WOODSTOCK
State : GA
Zip : 30189-5235
Country : US
Telephone Number : 770-926-0005
Fax Number : 770-926-0762
Provider Business Practice Location Address
First Line : 7450 HIGHWAY 92
Second Line : SUITE 110
City : WOODSTOCK
State : GA
Zip : 30189-5235
Country : US
Telephone Number : 770-926-0005
Fax Number : 770-926-0762
Authorized Official
Title or Position : PARTNER PRESIDENT
Name : DR. VIRGINIA SUTTON WOOD
Credential : PSY.D.
Telephone Number : 770-926-0005
Provider Enumeration Date : 01/03/2007
Last Update Date : 08/22/2020

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Directions to “NORTH GEORGIA PSYCHOTHERAPY SERVICES LLC ” Practice Location

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