Provider Demographics
NPI:1831252220
Name:SHOOK, RICHARD E (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:SHOOK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 DUNCAN DR NW UNIT 2714
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30156-0465
Mailing Address - Country:US
Mailing Address - Phone:770-514-0111
Mailing Address - Fax:404-592-4648
Practice Address - Street 1:800 KENNESAW AVE NW STE 320
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7945
Practice Address - Country:US
Practice Address - Phone:770-514-0111
Practice Address - Fax:404-592-4648
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1908103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00577607AMedicaid
GA00577607AMedicaid
GA5823333473Medicare UPIN