Provider Demographics
NPI:1962618082
Name:PETTONI, ASHLEY (PSYD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:PETTONI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 PIEDMONT RD NE
Mailing Address - Street 2:SUITE 56-298
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3086
Mailing Address - Country:US
Mailing Address - Phone:404-550-0388
Mailing Address - Fax:706-546-8456
Practice Address - Street 1:485 HUNTINGTON RD
Practice Address - Street 2:SUITE 199
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-1861
Practice Address - Country:US
Practice Address - Phone:706-546-8440
Practice Address - Fax:706-546-8456
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003250103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist