Provider Demographics
NPI:1205848017
Name:MCCOY, PATRICIA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W ACADEMY ST NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-8524
Mailing Address - Country:US
Mailing Address - Phone:770-535-1284
Mailing Address - Fax:770-536-3888
Practice Address - Street 1:200 W ACADEMY ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-8524
Practice Address - Country:US
Practice Address - Phone:770-535-1284
Practice Address - Fax:770-536-3888
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1856103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00637843BMedicaid
GA68BBFVNMedicare ID - Type Unspecified