Provider Demographics
NPI:1346546702
Name:NICK A DEFILIPPIS, PH.D., PC
Entity Type:Organization
Organization Name:NICK A DEFILIPPIS, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DEFILIPPIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-730-9930
Mailing Address - Street 1:990 HAMMOND DR NE
Mailing Address - Street 2:730
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:990 HAMMOND DR NE
Practice Address - Street 2:SUITE 730
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5529
Practice Address - Country:US
Practice Address - Phone:770-730-9930
Practice Address - Fax:770-730-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA536103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBCDWMedicare UPIN