Organization
GARY SANTAVICCA, PH.D. AND ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AYANNA RULE (INSURANCE MANAGER)
(404) 653-1117
Entity
Organization
Contact information
Practice address
340 BOULEVARD NE, SUITE 640, ATLANTA, GA 30312-1273
(404) 653-1117
(404) 880-0133
Mailing address
340 BOULEVARD NE, SUITE 640, ATLANTA, GA 30312-1273
(404) 653-1117
(404) 880-0133
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY001224
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00423178A
—
GA
05
—
00423178B
—
GA
Enumeration date
05/10/2007
Last updated
08/22/2020
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