| Theodore M Goetz Phd Pc | |
|
1751 S Lumpkin St Athens GA 30606-4740 | |
| (706) 548-9441 | |
| Not Available |
| Full Name | Theodore M Goetz Phd Pc |
|---|---|
| Speciality | Psychologist |
| Location | 1751 S Lumpkin St, Athens, Georgia |
| Authorized Official Name and Position | Theodore M Goetz (PSYCHOLOGIST) |
| Authorized Official Contact | 7065489441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theodore M Goetz Phd Pc 1751 S Lumpkin St Athens GA 30606-4740 Ph: (706) 548-9441 | Theodore M Goetz Phd Pc 1751 S Lumpkin St Athens GA 30606-4740 Ph: (706) 548-9441 |
| NPI Number | 1184991705 |
|---|---|
| Provider Enumeration Date | 11/28/2011 |
| Last Update Date | 11/28/2011 |
| Medicare PECOS PAC ID | 5991970816 |
|---|---|
| Medicare Enrollment ID | O20111205000521 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184991705 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 698 (Georgia) | Primary |
| Provider Name | Theodore Michael Goetz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669463766 PECOS PAC ID: 6800061722 Enrollment ID: I20111205000533 |
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