Provider Demographics
NPI:1659511079
Name:DUNWOODY PSYCHOLOGY, INC.
Entity Type:Organization
Organization Name:DUNWOODY PSYCHOLOGY, INC.
Other - Org Name:STEVEN KOVNER, PH.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-729-0123
Mailing Address - Street 1:3790 HOLCOMB BRIDGE RD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092
Mailing Address - Country:US
Mailing Address - Phone:770-729-0123
Mailing Address - Fax:
Practice Address - Street 1:3790 HOLCOMB BRIDGE RD.
Practice Address - Street 2:SUITE 201
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092
Practice Address - Country:US
Practice Address - Phone:770-729-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1842103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00638877HMedicaid
GA00638877HMedicaid