Individual
DR. ELIZABETH MARIE SOETY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
102 GUNN RD, CENTERVILLE, GA 31028
(478) 953-0088
(478) 953-0093
Mailing address
102 GUNN RD, CENTERVILLE, GA 31028-1706
(478) 953-0088
(478) 953-0093
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PSY002815
GA
103TC0700X
Clinical Psychologist
Primary
PSY002815
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
358345266A
—
GA
01
—
52703377
BLUE CROSS BLUE SHIELD
GA
Enumeration date
03/20/2006
Last updated
07/11/2018
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