Individual
DR. MARK J. PRIGATANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
146 PIERCE AVE, MACON, GA 31204-2871
(478) 746-2333
(478) 845-4493
Mailing address
146 PIERCE AVE, MACON, GA 31204-2871
(478) 746-2333
(478) 845-4493
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY001999
GA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY001999
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000730254C
—
GA
Enumeration date
08/04/2006
Last updated
03/21/2014
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