Provider Demographics
NPI:1588900062
Name:KOLIANI, ANDREW (PHD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KOLIANI
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 1:2325 BROOKSTONE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4500
Mailing Address - Country:US
Mailing Address - Phone:706-653-6841
Mailing Address - Fax:706-653-7843
Practice Address - Street 1:2325 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4500
Practice Address - Country:US
Practice Address - Phone:706-653-6841
Practice Address - Fax:706-653-7843
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003642103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist