Provider Demographics
NPI:1548254196
Name:ABELKOP, ADRIAN SHAYNE (PHD)
Entity type:Individual
Prefix:DR
First Name:ADRIAN SHAYNE
Middle Name:
Last Name:ABELKOP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 JENNINGS MILL RD UNIT 2200A
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7270
Mailing Address - Country:US
Mailing Address - Phone:706-431-3711
Mailing Address - Fax:888-425-0590
Practice Address - Street 1:1551 JENNINGS MILL RD UNIT 2200A
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7270
Practice Address - Country:US
Practice Address - Phone:706-431-3711
Practice Address - Fax:888-425-0590
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY #2799103TS0200X
GA2799103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA133309172AMedicaid