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Individual

DR. CHARLES E CANCILLA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
897 EVA KENNEDY RD, SUWANEE, GA 30024-1911
(404) 400-2547
Mailing address
2345 DUNCANS SHORE DR, BUFORD, GA 30519-6222
(404) 218-0180

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
4473
GA

Other

Enumeration date
12/22/2021
Last updated
12/22/2021
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