Provider Demographics
NPI:1912396631
Name:OVERMAN, XAN
Entity Type:Individual
Prefix:
First Name:XAN
Middle Name:
Last Name:OVERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 POINT NORTH PL
Mailing Address - Street 2:SUITE #6
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2654
Mailing Address - Country:US
Mailing Address - Phone:423-715-3816
Mailing Address - Fax:
Practice Address - Street 1:311 POINT NORTH PL
Practice Address - Street 2:SUITE #6
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2654
Practice Address - Country:US
Practice Address - Phone:423-715-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional