Provider Demographics
NPI:1295798486
Name:DEFILIPPIS, NICK A (PHD)
Entity type:Individual
Prefix:DR
First Name:NICK
Middle Name:A
Last Name:DEFILIPPIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:990 HAMMOND DR STE 575
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-9113
Mailing Address - Country:US
Mailing Address - Phone:770-730-9930
Mailing Address - Fax:770-730-0998
Practice Address - Street 1:990 HAMMOND DR NE
Practice Address - Street 2:SUITE 730
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5529
Practice Address - Country:US
Practice Address - Phone:770-730-9930
Practice Address - Fax:770-730-0998
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-09
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA536103TA0400X, 103G00000X, 103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00136309CMedicaid