Provider Demographics
NPI:1831109701
Name:CORALIE SCHERER, PHD, PA
Entity Type:Organization
Organization Name:CORALIE SCHERER, PHD, PA
Other - Org Name:CORALIE SCHERER, PHD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CORALIE
Authorized Official - Middle Name:ROSEN
Authorized Official - Last Name:SCHERER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-924-1818
Mailing Address - Street 1:8910 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4916
Mailing Address - Country:US
Mailing Address - Phone:770-924-1818
Mailing Address - Fax:770-928-5731
Practice Address - Street 1:8910 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4916
Practice Address - Country:US
Practice Address - Phone:770-924-1818
Practice Address - Fax:770-928-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY2647103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGRBMedicare UPIN