NPIMap

Organization Active NPI

Genpsych of South Carolina LLC

  • Psychiatry Physician
  • Sumter, SC
National Provider Identifier
1053629287
Registry record updated Dec 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
21075 Issued in SC
Legal business name
GENPSYCH OF SOUTH CAROLINA LLC
Practice address
2 Medical CT
Sumter, SC 29150-4760
Phone
(803) 774-4020
Fax
(803) 774-4025
NPI assigned
Sep 22, 2010
Organization subpart
Yes
Parent organization
GENPSYCH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 20, 2010

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

Authorized official

Name
Dr. Henry Odunlami
Title
Owner/Medical Director
Phone
(908) 231-0511

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 25MA07291000 NJ
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 21075 SC Primary

Addresses

Primary practice location

2 Medical CT
Sumter, SC 29150-4760

Mailing address

2 Medical CT
Sumter, SC 29150-4760
Phone (803) 774-4020

Other identifiers 1

IdentifierTypeStateIssuer
110BHSMedicaidSC

Other names 1

  • GenPsych Inc Other name

National Provider Directory

National Provider Directory
Tax ID family
Genpsych Inc2 organizations share this tax ID, including this one
Part of
Genpsych PC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2 Medical Ct
Sumter, SC 29150
Phone (803) 773-9417

NPI Registry JSON

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

{
    "created_epoch": "1285113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292803200000",
    "number": "1053629287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 MEDICAL CT",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504760",
            "telephone_number": "803-774-4020",
            "fax_number": "803-774-4025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEDICAL CT",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504760",
            "telephone_number": "803-774-4020",
            "fax_number": "803-774-4025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENPSYCH OF SOUTH CAROLINA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENPSYCH INC",
        "enumeration_date": "2010-09-22",
        "last_updated": "2010-12-20",
        "status": "A",
        "authorized_official_last_name": "ODUNLAMI",
        "authorized_official_first_name": "HENRY",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "908-231-0511",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA07291000",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "21075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110BHS",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GenPsych Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sumter, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.