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1223 E Mcpherson Ave Nashville GA 31639-2351 | |
| (229) 245-0330 | |
| (866) 738-7755 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1223 E Mcpherson Ave, Nashville, Georgia |
| Authorized Official Name and Position | Wandamaria Lopez (PSYCHOLOGIST) |
| Authorized Official Contact | 2292450330 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2828 Valdosta GA 31604-2828 Ph: (229) 245-0330 | 1223 E Mcpherson Ave Nashville GA 31639-2351 Ph: (229) 245-0330 |
| NPI Number | 1437282431 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 03/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437282431 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY001532 (Georgia) | Primary |
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