Organization
MICHAEL BUCOVETSKY, PSY.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL BUCOVETSKY PSY.D. (PSYCHOLOGIST)
(770) 457-5577
Entity
Organization
Contact information
Practice address
2308 PERIMETER PARK DR STE 100, ATLANTA, GA 30341-1316
(770) 457-5577
(770) 457-5599
Mailing address
2308 PERIMETER PARK DR STE 100, ATLANTA, GA 30341-1316
(770) 457-5577
(770) 457-5599
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY003351
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
253866155A
—
GA
Enumeration date
07/02/2010
Last updated
07/02/2010
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