Provider Demographics
NPI:1992164339
Name:J M ATWATER, PHD
Entity type:Organization
Organization Name:J M ATWATER, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:M
Authorized Official - Last Name:ATWATER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-694-1887
Mailing Address - Street 1:4362 NORTHLAKE BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6275
Mailing Address - Country:US
Mailing Address - Phone:561-694-1887
Mailing Address - Fax:561-626-2131
Practice Address - Street 1:4362 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6275
Practice Address - Country:US
Practice Address - Phone:561-694-1887
Practice Address - Fax:561-626-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-13
Last Update Date:2016-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003419103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75654Medicare UPIN