Individual
DR. MARIA E GANGAROSA-EMERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
302 BASTON RD, MARTINEZ, GA 30907-2906
(706) 447-8700
(706) 447-8701
Mailing address
PO BOX 2854, EVANS, GA 30809-2854
(706) 447-8700
(706) 447-8701
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
2381
GA
103TC0700X
Clinical Psychologist
Primary
PSY 0002381
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000852277B
—
GA
01
—
020657518
FED TAX ID
GA
01
—
020657518001
FED TAX ID
GA
01
—
52669312-001
INS ID
GA
Enumeration date
05/17/2007
Last updated
02/19/2012
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