Provider Demographics
NPI:1497743512
Name:CARDOZO, PAUL J (EDD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:CARDOZO
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HAWTHORNE PARK
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2164
Mailing Address - Country:US
Mailing Address - Phone:706-546-9880
Mailing Address - Fax:706-353-3772
Practice Address - Street 1:215 HAWTHORNE PARK
Practice Address - Street 2:SUITE A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2164
Practice Address - Country:US
Practice Address - Phone:706-546-9880
Practice Address - Fax:706-353-3772
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA821103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000348323AMedicaid