Individual provider Active NPI

Bryan Mild Golson, LPC

  • Professional Counselor
  • Duluth, GA
National Provider Identifier
1033992805
Registry record updated Aug 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Practice address
3350 Breckinridge Blvd Ste 200
Duluth, GA 30096-4959
Phone
(770) 962-8396
NPI assigned
Aug 16, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X Primary

Addresses

Primary practice location

3350 Breckinridge Blvd Ste 200
Duluth, GA 30096-4959

Mailing address

3350 Breckinridge Blvd Ste 200
Duluth, GA 30096-4959
Phone (770) 962-8396

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240131000322 GA Practitioner - Mental Health Counselor 4981057569 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Positive Impact Health Centers Inc CurrentSince Jan 1, 2024 Accepting new patients
Positive Impact Health Centers, Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

3350 Breckinridge Blvd
Ste 200
Duluth, GA 30096
Phone (770) 962-8396

3075 Breckinridge Blvd
Ste 415
Duluth, GA 30096
Phone (770) 962-8396

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/6123adb2-d0d2-485a-9dcf-5fba87efb2ef/

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1692144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692144000000",
    "number": "1033992805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 BRECKINRIDGE BLVD STE 200",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964959",
            "telephone_number": "770-962-8396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 BRECKINRIDGE BLVD STE 200",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964959",
            "telephone_number": "770-962-8396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLSON",
        "first_name": "BRYAN",
        "middle_name": "MILD",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-16",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, GA

Sources for this page

Verify at the official NPI Registry.