Provider Demographics
NPI:1336221191
Name:GAM, JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GAM
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 1:121 N 20TH ST #6
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801
Mailing Address - Country:US
Mailing Address - Phone:334-749-3385
Mailing Address - Fax:334-705-3431
Practice Address - Street 1:121 N 20TH ST #6
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801
Practice Address - Country:US
Practice Address - Phone:334-705-3322
Practice Address - Fax:334-705-3431
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000030450Medicaid
AL000030450Medicaid
AL051030450Medicare PIN