Provider Demographics
NPI:1689730707
Name:WILLIAM R. MCGOWAN, PH.D. LICENSED PSYCHOLOGIST, P.C.
Entity Type:Organization
Organization Name:WILLIAM R. MCGOWAN, PH.D. LICENSED PSYCHOLOGIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-324-4919
Mailing Address - Street 1:4015 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6851
Mailing Address - Country:US
Mailing Address - Phone:706-324-4919
Mailing Address - Fax:706-324-4960
Practice Address - Street 1:4015 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6851
Practice Address - Country:US
Practice Address - Phone:706-324-4919
Practice Address - Fax:706-324-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1407103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGSVMedicare ID - Type UnspecifiedPSYCHOLOGIST