Provider Demographics
NPI:1063482263
Name:KOVNER, STEVEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:KOVNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3790 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4801
Mailing Address - Country:US
Mailing Address - Phone:770-312-2319
Mailing Address - Fax:770-729-0123
Practice Address - Street 1:3790 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4801
Practice Address - Country:US
Practice Address - Phone:770-312-2319
Practice Address - Fax:770-729-0123
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSYGA001842103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00638877HMedicaid
GA68BBDFGMedicare ID - Type Unspecified
GA00638877HMedicaid