| Gary Santavicca, Ph.d. And Associates | |
|
340 Boulevard Ne Suite 640 Atlanta GA 30312-1273 | |
| (404) 653-1117 | |
| (404) 880-0133 |
| Full Name | Gary Santavicca, Ph.d. And Associates |
|---|---|
| Speciality | Psychologist |
| Location | 340 Boulevard Ne, Atlanta, Georgia |
| Authorized Official Name and Position | Ayanna Rule (INSURANCE MANAGER) |
| Authorized Official Contact | 4046531117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary Santavicca, Ph.d. And Associates 340 Boulevard Ne Suite 640 Atlanta GA 30312-1273 Ph: (404) 653-1117 | Gary Santavicca, Ph.d. And Associates 340 Boulevard Ne Suite 640 Atlanta GA 30312-1273 Ph: (404) 653-1117 |
| NPI Number | 1518171222 |
|---|---|
| Provider Enumeration Date | 05/10/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9335220409 |
|---|---|
| Medicare Enrollment ID | O20080116000602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518171222 | NPI | - | NPPES |
| 00423178B | Medicaid | GA | |
| 00423178A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY001224 (Georgia) | Primary |
| Provider Name | Gary S Santavicca |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124080395 PECOS PAC ID: 4688755747 Enrollment ID: I20080115000140 |
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