Provider Demographics
NPI:1982846671
Name:ANDERSON, LOUIS P (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:P
Last Name:ANDERSON
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 1:130 RISING MIST DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-1846
Mailing Address - Country:US
Mailing Address - Phone:770-306-6608
Mailing Address - Fax:
Practice Address - Street 1:120 MICHAEL CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-1846
Practice Address - Country:US
Practice Address - Phone:404-405-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34022103TC0700X
MS45-727103TC0700X
GAPSY001114103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical