Provider Demographics
NPI:1851626105
Name:ASHLEY N. PETTONI, PSY.D., PC
Entity Type:Organization
Organization Name:ASHLEY N. PETTONI, PSY.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:PETTONI
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:404-550-0388
Mailing Address - Street 1:2625 PIEDMONT RD NE
Mailing Address - Street 2:56-298
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3086
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:485 HUNTINGTON RD
Practice Address - Street 2:201
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-1861
Practice Address - Country:US
Practice Address - Phone:706-546-8440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003250103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA364591572AMedicaid
GA364591572BMedicaid