Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2903 | GA |
N | 103T00000X | Psychologist | 2903 | GA |
N | 103G00000X | Clinical Psychologist | 2903 | GA |
N | 103TC0700X | Clinical Psychologist | 2903 | GA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2903 | GA |
N | 103TE1100X | Exercise & Sports Psychologist | 2903 | GA |
N | 103TR0400X | Rehabilitation Psychologist | 2903 | GA |
NPI | 1285619502 |
---|---|
Provider Name | Dr. Keith Monroe |
First Address | Augusta, GA 30904-6285 |
Second Address | Augusta, GA 30904-6285 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 08/07/2007 |