Provider Demographics
NPI:1932279205
Name:MECK, DONALD S (PHD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:S
Last Name:MECK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2278 MOODY RD STE D
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-1933
Mailing Address - Country:US
Mailing Address - Phone:478-929-0294
Mailing Address - Fax:478-923-9770
Practice Address - Street 1:2278 MOODY RD STE D
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-1933
Practice Address - Country:US
Practice Address - Phone:478-929-0294
Practice Address - Fax:478-923-9770
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA619103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA62TCCTNMedicare ID - Type Unspecified
GAR70774Medicare UPIN