Individual
DR. PHYLLIS D IVERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
655 7TH ST BLDG 700700-A, 78 MDG/SGOW, ROBINS AFB, GA 31098-2227
(478) 327-8398
Mailing address
217 AMBER DR, BYRON, GA 31008-3876
(678) 447-7211
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY003523
GA
Other
Enumeration date
06/14/2012
Last updated
09/10/2012
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