Organization
JOHN AZAR-DICKENS, PH.D.,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN AZAR-DICKENS PH.D. (LICENSED PSYCHOLOGIST)
(706) 234-0659
Entity
Organization
Contact information
Practice address
109 JOHN MADDOX DR NW, ROME, GA 30165-1451
(706) 232-6743
Mailing address
PO BOX 1008, ROME, GA 30162-1008
(706) 232-6743
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
002459
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00895837J
—
GA
Enumeration date
06/29/2010
Last updated
06/29/2010
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