NPIMap

Organization Active NPI

Lifespan Psychology, P.C.

  • Clinical Child & Adolescent Psychologist
  • Hamilton, GA
National Provider Identifier
1003205741
Registry record updated Jan 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
PSY003142 Issued in GA
Legal business name
LIFESPAN PSYCHOLOGY, P.C.
Practice address
98 Voorhees Rd E
Hamilton, GA 31811-5671
Phone
(954) 260-0361
NPI assigned
Jan 19, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kevin James Weis, PSY.D.NPI 1699791541
Title
Chairman
Phone
(954) 260-0361

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103G00000X PSY003141 GA
Clinical Child & Adolescent PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC2200X PSY003142 GA Primary

Addresses

Primary practice location

98 Voorhees Rd E
Hamilton, GA 31811-5671

Mailing address

98 Voorhees Rd E
Hamilton, GA 31811-5671
Phone (706) 582-3647

Other identifiers 2

IdentifierTypeStateIssuer
712348695AMedicaidGA
313423941AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150610001422 GA Part B Supplier - Clinic/Group Practice 0840511291 Receives reassigned benefits from 2 practitioners
Practice locations: Columbus, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421884800000",
    "number": "1003205741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 VOORHEES RD E",
            "city": "HAMILTON",
            "state": "GA",
            "postal_code": "318115671",
            "telephone_number": "706-582-3647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 VOORHEES RD E",
            "city": "HAMILTON",
            "state": "GA",
            "postal_code": "318115671",
            "telephone_number": "954-260-0361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN PSYCHOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-19",
        "last_updated": "2015-01-22",
        "status": "A",
        "authorized_official_last_name": "WEIS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CHAIRMAN",
        "authorized_official_telephone_number": "954-260-0361",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "GA",
            "license": "PSY003141",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "GA",
            "license": "PSY003142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "712348695A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "313423941A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamilton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.