Decatur Psychology, Llc | |
101 Birch St Decatur GA 30030-3340 | |
(404) 513-6077 | |
(404) 478-6823 |
Full Name | Decatur Psychology, Llc |
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Speciality | Psychologist |
Location | 101 Birch St, Decatur, Georgia |
Authorized Official Name and Position | John Rackley Lucy (OWNER) |
Authorized Official Contact | 4045136077 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Decatur Psychology, Llc 101 Birch St Decatur GA 30030-3340 Ph: (404) 513-6077 | Decatur Psychology, Llc 101 Birch St Decatur GA 30030-3340 Ph: (404) 513-6077 |
NPI Number | 1194013912 |
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Provider Enumeration Date | 07/13/2011 |
Last Update Date | 05/26/2021 |
Certification Date | 05/26/2021 |
Medicare PECOS PAC ID | 9032372834 |
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Medicare Enrollment ID | O20120515000029 |
Identifier | Type | State | Issuer |
---|---|---|---|
1194013912 | NPI | - | NPPES |
1134380322 | Other | GA | INDIVIDUAL NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | PSY001911 (Georgia) | Primary |
Provider Name | John R Lucy |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1134380322 PECOS PAC ID: 7012081433 Enrollment ID: I20080804000244 |
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