1477696532 NPI number — DR. JOHN POST SHALLCROSS PSY.D.

Table of content: DR. JOHN POST SHALLCROSS PSY.D. (NPI 1477696532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477696532 NPI number — DR. JOHN POST SHALLCROSS PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHALLCROSS
Provider First Name:
JOHN
Provider Middle Name:
POST
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477696532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1660 HIGHGROVE CLUB DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30004-6983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-663-0923
Provider Business Mailing Address Fax Number:
770-663-6256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11755 POINTE PL
Provider Second Line Business Practice Location Address:
STE. A-1
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076-4636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-663-0923
Provider Business Practice Location Address Fax Number:
770-663-6256
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  GA 001666 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 582006242 . This is a "TAX ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00695912B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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