Provider Demographics
NPI:1437177433
Name:FISHER, ERIK A (PHD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:A
Last Name:FISHER
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 1:285 S PERRY ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-4840
Mailing Address - Country:US
Mailing Address - Phone:770-513-0577
Mailing Address - Fax:770-513-3884
Practice Address - Street 1:285 S PERRY STREET
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-5621
Practice Address - Country:US
Practice Address - Phone:770-513-0577
Practice Address - Fax:770-513-3884
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001913103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGLDMedicare PIN