Individual
RALPH A. GILLIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-4588
(706) 721-7264
Mailing address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY002225
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000824623B
—
GA
05
—
PS03332
—
SC
Enumeration date
08/30/2006
Last updated
04/27/2021
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