Individual provider Active NPI

Mary Vessel, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1053880849
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN165645 Issued in GA
Practice address
2900 Chamblee Tucker Rd BLDG 16
Atlanta, GA 30341-4148
Phone
(770) 939-1288
NPI assigned
Nov 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN165645 GA Primary

Addresses

Primary practice location

2900 Chamblee Tucker Rd BLDG 16
Atlanta, GA 30341-4148

Mailing address

652 Ormewood Ave SE
Atlanta, GA 30312-3618
Phone (404) 759-5262

Other identifiers 1

IdentifierTypeStateIssuer
003214635AMedicaidGA

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220815001040 GA Practitioner - Nurse Practitioner 4183007768 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Highland Rivers Community Service BoardGroup PAC ID 9032000245, 57 clinicians

Practice addresses (Care Compare)

191 Lamar Haley Pkwy
Canton, GA 30114-8019
Phone (770) 720-3510

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Highland Rivers Community Service Board CurrentSince Jun 1, 2022 Accepting new patients
Highland Rivers CSB CurrentSince Jun 1, 2022 Accepting new patients

Locations

191 Lamar Haley Pkwy
Canton, GA 30114
Phone (770) 704-1600

1503 N Tibbs Rd
Dalton, GA 30720
Phone (706) 229-4507

1179 Progress Rd
Ellijay, GA 30540
Phone (706) 635-2739

1650 County Services Pkwy SW
Marietta, GA 30008
Phone (770) 514-2300

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": "1542758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1053880849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "652 ORMEWOOD AVE SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303123618",
            "telephone_number": "404-759-5262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 CHAMBLEE TUCKER RD BLDG 16",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303414148",
            "telephone_number": "770-939-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VESSEL",
        "first_name": "MARY",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-21",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN165645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003214635A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.