Provider Demographics
NPI:1477600906
Name:PIKE, ANN SIDWELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:SIDWELL
Last Name:PIKE
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 1:201 COVE RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1356
Mailing Address - Country:US
Mailing Address - Phone:706-253-9515
Mailing Address - Fax:706-253-9516
Practice Address - Street 1:201 COVE RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1356
Practice Address - Country:US
Practice Address - Phone:706-253-9515
Practice Address - Fax:706-253-9516
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1346103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00425092BMedicaid
GA00425092BMedicaid
GA68BBFNHMedicare PIN