Provider Demographics
NPI:1629108642
Name:ZUKOTYNSKI, GEORGE ELLIOTT (PHD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ELLIOTT
Last Name:ZUKOTYNSKI
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 1:3229 NOLEN LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-6222
Mailing Address - Country:US
Mailing Address - Phone:615-591-4502
Mailing Address - Fax:
Practice Address - Street 1:3229 NOLEN LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-6222
Practice Address - Country:US
Practice Address - Phone:615-591-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC841103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities