| John P Shallcross, Psy.d., P.c. | |
|
11755 Pointe Pl Roswell GA 30076-4656 | |
| (770) 663-0923 | |
| (770) 663-6256 |
| Full Name | John P Shallcross, Psy.d., P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 11755 Pointe Pl, Roswell, Georgia |
| Authorized Official Name and Position | John Post Shallcross (PRESIDENT) |
| Authorized Official Contact | 7706630923 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John P Shallcross, Psy.d., P.c. 1660 Highgrove Club Dr Alpharetta GA 30004-6983 Ph: (770) 663-0923 | John P Shallcross, Psy.d., P.c. 11755 Pointe Pl Roswell GA 30076-4656 Ph: (770) 663-0923 |
| NPI Number | 1023309481 |
|---|---|
| Provider Enumeration Date | 04/20/2011 |
| Last Update Date | 04/20/2011 |
| Medicare PECOS PAC ID | 7416170964 |
|---|---|
| Medicare Enrollment ID | O20140602001023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023309481 | NPI | - | NPPES |
| 00695912B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 001666 (Georgia) | Primary |
| Provider Name | John Shallcross |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477696532 PECOS PAC ID: 7214150762 Enrollment ID: I20140602001110 |
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