Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 030672 | GA |
NPI | 1043740772 |
---|---|
Provider Name | Dr. John Acomb |
First Address | Marietta, GA 30066-1473 |
Second Address | Marietta, GA 30066-1473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2017 |
Last Update Date | 15/06/2017 |