Provider Demographics
NPI:1083183966
Name:ORR, DAVID THORNTON
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:THORNTON
Last Name:ORR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1443
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-1443
Mailing Address - Country:US
Mailing Address - Phone:904-534-1343
Mailing Address - Fax:
Practice Address - Street 1:5 S PUBLIC SQ STE 104
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3354
Practice Address - Country:US
Practice Address - Phone:904-534-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health