Individual
DR. MICHAEL JOHN CREDIDIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY D
Contact information
Practice address
2 LEE STREET, SUITE A, NEWNAN, GA 30263-7508
(678) 326-4488
(678) 669-2693
Mailing address
2 LEE ST, SUITE A, NEWNAN, GA 30263-1915
(678) 326-4488
(678) 669-2693
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY002670
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281868610A
—
GA
05
—
281868610C
—
GA
Enumeration date
12/19/2006
Last updated
04/02/2014
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