Individual
GARY THOMAS KITTRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
604 S 8TH ST # B, GRIFFIN, GA 30224-4214
(770) 228-0077
Mailing address
522 S HILL ST, GRIFFIN, GA 30224-4228
(770) 228-0077
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY001663
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101343
CENPATICO
GA
01
—
52404519 001
BCBS PROVIDER #
GA
Enumeration date
12/07/2006
Last updated
07/08/2007
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