Provider Demographics
NPI:1093858854
Name:SASS, JOHN R (PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:SASS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2296 HENDERSON MILL ROAD NE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345
Mailing Address - Country:US
Mailing Address - Phone:404-929-9009
Mailing Address - Fax:404-929-9005
Practice Address - Street 1:2296 HENDERSON MILL ROAD NE
Practice Address - Street 2:SUITE 305
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345
Practice Address - Country:US
Practice Address - Phone:404-929-9009
Practice Address - Fax:404-929-9005
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPSY0001727103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGLWMedicare PIN
GAQ33398Medicare UPIN
GA68BBGLWMedicare ID - Type UnspecifiedPROVIDER NUMBER
GAGRP4415Medicare ID - Type UnspecifiedGROUP NUMBER