Basic Information
| Provider Information | |||||||||
| NPI: | 1922236769 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDWARD M DROHAN PHD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2618 RIVER DR | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314043245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123502274 | ||||||||
| FaxNumber: | 9123508427 | ||||||||
| Practice Location | |||||||||
| Address1: | 2618 RIVER DR | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314043245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123502274 | ||||||||
| FaxNumber: | 9123508427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2009 | ||||||||
| LastUpdateDate: | 04/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | DROHAN | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9123502274 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | PH.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY0001287 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 00393456C | 05 | GA | MEDICAID |