DR. JOHN SCOTT BARANCHOK PHD
Clinical Neuropsychologist
Rome, Georgia
Provider NPI: 1578542510
Provider Information:DR. JOHN SCOTT BARANCHOK PHD
Gender: M
Sole Proprietor
Practice Location:
504 RIVERSIDE PKWY NE SUITE 300 ROME, GA 30161 US
Tel: 706-290-0535 Fax: 706-290-1421
Business Mailing Address:
504 RIVERSIDE PKWY NE SUITE 300 ROME, GA 30161 US
Tel: 706-290-0535 Fax: 706-290-1421
Entity Type: Individual
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 103G00000X | Behavioral Health & Social Service Providers Clinical Neuropsychologist | GA | 2010 |
N | 103TC0700X | Behavioral Health & Social Service Providers Psychologist | GA | PSY002010 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
EIN MUMBER | 522415894 | GA | 01 |
000793174C | GA | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin