Provider Demographics
NPI:1154359263
Name:ACKER, DAVID WILLIAM (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:ACKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 TEBEAU ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6359
Mailing Address - Country:US
Mailing Address - Phone:912-283-5676
Mailing Address - Fax:912-283-5604
Practice Address - Street 1:2002 TEBEAU ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6359
Practice Address - Country:US
Practice Address - Phone:912-283-5676
Practice Address - Fax:912-283-5604
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002038103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00375666DMedicaid
GA00375666DMedicaid