Santavicca, Gary
Santavicca, Gary is an individual health care provider with primary practice located at 340 Blvd Ne Ste 640, Atlanta GA 30312. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Santavicca, Gary can be contacted via phone (404) 653-1117.Contact Information
Primary practice address
340 Blvd Ne Ste 640
Atlanta GA 30312
Phone: (404) 653-1117
Fax: (404) 880-0133
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 1224 | Georgia |
Profile Details
| NPI number | 1124080395 |
|---|---|
| LBN Legal business name | Santavicca, Gary |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 4th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124080395 | NPPES |
| Georgia | MEDICAID | 00423178A |
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