Provider Demographics
NPI:1790901742
Name:MEDICAL & REHABILITATION PSYCHOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MEDICAL & REHABILITATION PSYCHOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:912-355-5112
Mailing Address - Street 1:836 E. 65TH ST.
Mailing Address - Street 2:STE. 3
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-355-5112
Mailing Address - Fax:912-355-5156
Practice Address - Street 1:836 E 65TH ST
Practice Address - Street 2:STE 3
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4411
Practice Address - Country:US
Practice Address - Phone:912-355-5112
Practice Address - Fax:912-355-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000693103TC0700X
GAPSY001478103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty