Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 0799 | GA |
Y | 103T00000X | Psychologist | 0799 | GA |
N | 102L00000X | Psychologist | 799 | GA |
N | 103T00000X | Psychologist | 799 | GA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 799 | GA |
N | 103G00000X | Clinical Psychologist | 799 | GA |
N | 103TC0700X | Clinical Psychologist | 799 | GA |
NPI | 1336126507 |
---|---|
Provider Name | Dr. Charles A. Dillion |
First Address | Atlanta, GA 30319 |
Second Address | Atlanta, GA 30319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 24/04/2009 |