Provider Demographics
NPI:1194857813
Name:TURCO, TIMOTHY (PHD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:TURCO
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 1:1048 MOUNTAIN VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:31822-2546
Mailing Address - Country:US
Mailing Address - Phone:706-457-7673
Mailing Address - Fax:
Practice Address - Street 1:107 BROAD ST.
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:31822
Practice Address - Country:US
Practice Address - Phone:706-457-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002346103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA913515611AMedicaid