Provider Demographics
NPI:1881137305
Name:VOJTA, TIMOTHY (APC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:VOJTA
Suffix:
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3857 FLOWERLAND DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1803
Mailing Address - Country:US
Mailing Address - Phone:404-441-0338
Mailing Address - Fax:
Practice Address - Street 1:3754 LAVISTA RD STE 200
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5627
Practice Address - Country:US
Practice Address - Phone:770-810-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health