Active NPI
Micgra Telehealth LLLP
- Psychiatric/Mental Health Nurse Practitioner
- Dallas, GA
National Provider Identifier
1013548981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- Legal business name
- MICGRA TELEHEALTH LLLP
- Practice address
- 301 White Ingram Pkwy Ste C
Dallas, GA 30132-5066 - Phone
- (404) 751-3700
- NPI assigned
- Jan 30, 2020
- Organization subpart
- Yes
- Parent organization
- MICGRA TELEHEALTH LLLP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Odette Amanda Butler, NP
- Title
- Owner
- Phone
- (404) 751-3700
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | Primary |
Addresses
Primary practice location
301 White Ingram Pkwy Ste C
Dallas, GA 30132-5066
Mailing address
301 W I Pkwy Ste C
Dallas, GA 30132-5066
Phone (800) 867-1024
Other practice location 1
555 Andover Park W Ste 200
Tukwila, WA 98188-3379
Phone (800) 867-1024
Other names 1
- Micgra Psych LLC
National Provider Directory
National Provider Directory- Part of
- Micgra Telehealth LLLP
Locations
301 White Ingram Pkwy
Ste C
Dallas, GA 30132
Phone (404) 751-3700
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Psychiatric/Mental Health Nurse Practitioner
- Phoenix, AZ
- NPI 1669906228
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580342400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1770163200000",
"number": "1013548981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 W I PKWY STE C",
"city": "DALLAS",
"state": "GA",
"postal_code": "301325066",
"telephone_number": "800-867-1024",
"fax_number": "206-485-4710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 WHITE INGRAM PKWY STE C",
"city": "DALLAS",
"state": "GA",
"postal_code": "301325066",
"telephone_number": "404-751-3700"
}
],
"practiceLocations": [
{
"address_1": "555 Andover Park W Ste 200",
"address_purpose": "LOCATION",
"city": "Tukwila",
"state": "WA",
"postal_code": "981883379",
"country_code": "US",
"telephone_number": "800-867-1024",
"fax_number": "206-485-4710",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "MICGRA TELEHEALTH LLLP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MICGRA TELEHEALTH LLLP",
"enumeration_date": "2020-01-30",
"last_updated": "2026-02-04",
"certification_date": "2026-02-04",
"status": "A",
"authorized_official_last_name": "BUTLER",
"authorized_official_first_name": "ODETTE AMANDA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "404-751-3700",
"authorized_official_credential": "NP"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Micgra Psych LLC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Dallas, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.