| Grace Psychotherapy & Psychological Assesment Services Of North Ga | |
|
1 Huntington Rd Suite 801 Athens GA 30606-7204 | |
| (706) 552-0450 | |
| (706) 850-7211 |
| Full Name | Grace Psychotherapy & Psychological Assesment Services Of North Ga |
|---|---|
| Speciality | Psychologist |
| Location | 1 Huntington Rd, Athens, Georgia |
| Authorized Official Name and Position | John F Grace (OWNER) |
| Authorized Official Contact | 7065520450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Psychotherapy & Psychological Assesment Services Of North Ga 1 Huntington Rd Suite 801 Athens GA 30606-7204 Ph: (706) 552-0450 | Grace Psychotherapy & Psychological Assesment Services Of North Ga 1 Huntington Rd Suite 801 Athens GA 30606-7204 Ph: (706) 552-0450 |
| NPI Number | 1093062606 |
|---|---|
| Provider Enumeration Date | 08/14/2012 |
| Last Update Date | 11/05/2012 |
| Medicare PECOS PAC ID | 7315198124 |
|---|---|
| Medicare Enrollment ID | O20121102000452 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093062606 | NPI | - | NPPES |
| 476047042A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY003032 (Georgia) | Primary |
| Provider Name | John F Grace |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487799664 PECOS PAC ID: 6507961075 Enrollment ID: I20121107000671 |
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