Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 536 | GA |
N | 103TC0700X | Clinical Psychologist | 536 | GA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 536 | GA |
Y | 103G00000X | Clinical Psychologist | 536 | GA |
Y | 103TC0700X | Clinical Psychologist | 536 | GA |
N | 103TF0200X | Forensic Psychologist | 536 | GA |
NPI | 1295798486 |
---|---|
Provider Name | Dr. Nick A Defilippis |
First Address | Atlanta, GA 30328-9113 |
Second Address | Atlanta, GA 30328-5529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2006 |
Last Update Date | 12/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00136309C | (05) | GA |