Provider Demographics
NPI:1598814725
Name:PANYE, DOUGLAS STARLING (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:STARLING
Last Name:PANYE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:PSYCHOLOGICAL
Other - Middle Name:SPECIALISTS
Other - Last Name:OF AUGUSTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 211008
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30917-1008
Mailing Address - Country:US
Mailing Address - Phone:706-860-1122
Mailing Address - Fax:706-860-3839
Practice Address - Street 1:3990 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-2220
Practice Address - Country:US
Practice Address - Phone:706-860-1122
Practice Address - Fax:706-860-3839
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000873103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1366Medicare UPIN