DAVID ROSS ATKINSON, PHD - NPI NUMBER 1417086554

Summary

Provider Name: DAVID ROSS ATKINSON, PHD

NPI Number: 1417086554

Clasification: Clinical Neuropsychologist (103G00000X)

Address:
1428 PHILLIPS LN
SUITE 300
SAN LUIS OBISPO, CA
ZIP 93401

Phone Number: (805) 545-5720



Detailed Information

David Ross Atkinson, PHD is a clinical neuropsychologist in San Luis Obispo, CA. The provider is an individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. The assigned NPI number for this provider is 1417086554 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business address is:

1428 PHILLIPS LN
SUITE 300
SAN LUIS OBISPO, CA
ZIP 93401-537
Phone: (805) 545-5720
Fax: (805) 545-5727

The enumeration date for this NPI number is 3/5/2007 and was last updated on 7/8/2007.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1336209774 DR. THOMAS FREDERICK WYLIE, PH.D.
Clinical Neuropsychologist

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 103G00000X Clinical Neuropsychologist PSY6801 CA X
2 103TC0700X Psychologist Clinical PSY6801 CA X

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 CP6801 MEDICARE ID-TYPE UNSPECIFIED CA

NPI Record

No. Field Name Field Value
1 NPI 1417086554
2 Entity Type Code 1
3 Provider Last Name Legal Name ATKINSON
4 Provider First Name DAVID
5 Provider Middle Name ROSS
6 Provider Credential Text PHD
7 Provider First Line Business Practice Location Address 1428 PHILLIPS LN
8 Provider Second Line Business Practice Location Address SUITE 300
9 Provider Business Practice Location Address City Name SAN LUIS OBISPO
10 Provider Business Practice Location Address State Name CA
11 Provider Business Practice Location Address Postal Code 934012537
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 8055455720
14 Provider Business Practice Location Address Fax Number 8055455727
15 Provider Enumeration Date 3/5/2007
16 Last Update Date 7/8/2007
17 Provider Gender Code M
18 Healthcare Provider Taxonomy Code 1 103G00000X
19 Provider License Number 1 PSY6801
20 Provider License Number State Code 1 CA
21 Healthcare Provider Primary Taxonomy Switch 1 X
22 Healthcare Provider Taxonomy Code 2 103TC0700X
23 Provider License Number 2 PSY6801
24 Provider License Number State Code 2 CA
25 Healthcare Provider Primary Taxonomy Switch 2 X
26 Other Provider Identifier 1 CP6801
27 Other Provider Identifier Type Code 1 04
28 Other Provider Identifier State 1 CA
29 Is Sole Proprietor Y

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.