Provider Demographics
NPI:1376650796
Name:SCARBOROUGH, ZANE T (PHD)
Entity Type:Individual
Prefix:DR
First Name:ZANE
Middle Name:T
Last Name:SCARBOROUGH
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 1:16 EASTBROOK BND
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1568
Mailing Address - Country:US
Mailing Address - Phone:770-703-4726
Mailing Address - Fax:770-703-5052
Practice Address - Street 1:16 EASTBROOK BND
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1568
Practice Address - Country:US
Practice Address - Phone:770-703-4726
Practice Address - Fax:770-703-5052
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002947103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA514668318CMedicaid
GA514668318AMedicaid