Provider Demographics
NPI:1376726133
Name:PRICE, JOHN RYAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RYAN
Last Name:PRICE
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:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:NC
Mailing Address - Zip Code:27342-0174
Mailing Address - Country:US
Mailing Address - Phone:919-791-7978
Mailing Address - Fax:336-447-4482
Practice Address - Street 1:24 NW COURT SQ
Practice Address - Street 2:STE 302
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-2860
Practice Address - Country:US
Practice Address - Phone:919-791-7978
Practice Address - Fax:336-447-4482
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3597103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5954171OtherAETNA
NC6001113Medicaid