Provider Demographics
NPI:1508965500
Name:ALBRECHT, JOHN WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:ALBRECHT
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 1:1173 SUMTER LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5501
Mailing Address - Country:US
Mailing Address - Phone:706-787-6377
Mailing Address - Fax:706-787-1458
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:OUTPATIENT BEHAVIORAL HEALTH
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-6377
Practice Address - Fax:706-787-1458
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01854103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist