| Psychological Affiliates | |
|
122 Cherry St Ne Marietta GA 30060-7206 | |
| (770) 427-2911 | |
| Not Available |
| Full Name | Psychological Affiliates |
|---|---|
| Speciality | Psychologist |
| Location | 122 Cherry St Ne, Marietta, Georgia |
| Authorized Official Name and Position | Jack Holland Grisham (PRESIDENT) |
| Authorized Official Contact | 7704272911 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological Affiliates 122 Cherry St Ne Marietta GA 30060-7206 Ph: (770) 427-2911 | Psychological Affiliates 122 Cherry St Ne Marietta GA 30060-7206 Ph: (770) 427-2911 |
| NPI Number | 1376728394 |
|---|---|
| Provider Enumeration Date | 01/09/2008 |
| Last Update Date | 01/09/2008 |
| Medicare PECOS PAC ID | 6406840651 |
|---|---|
| Medicare Enrollment ID | O20040412001024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376728394 | NPI | - | NPPES |
| Provider Name | Imogine Brodsky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225190796 PECOS PAC ID: 7315999778 Enrollment ID: I20070726000412 |
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