Provider Demographics
NPI:1134489503
Name:ANN PRIDDY LCSW PC
Entity Type:Organization
Organization Name:ANN PRIDDY LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRIDDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LMFT
Authorized Official - Phone:229-483-5050
Mailing Address - Street 1:1511 W 3RD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3695
Mailing Address - Country:US
Mailing Address - Phone:229-483-5050
Mailing Address - Fax:229-485-1103
Practice Address - Street 1:1511 W 3RD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3695
Practice Address - Country:US
Practice Address - Phone:229-483-5050
Practice Address - Fax:229-485-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-20
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW001337251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA899829779AMedicaid
GA1982688198OtherINDIVIDUAL NPI NUMBER
GA1982688198OtherINDIVIDUAL NPI NUMBER