Active NPI
Marat V. Zanov
- Clinical Psychologist
- Fort Gregg-Adams, VA
National Provider Identifier
1063660793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 26283
- Practice address
- Kenner Army Health Clinic
700 24TH Street
Fort Gregg-Adams, VA 23801 - Phone
- (804) 734-9143
- Fax
- (804) 734-9188
- NPI assigned
- Sep 6, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 26283 | CA | Primary |
Addresses
Primary practice location
Kenner Army Health Clinic
700 24TH Street
Fort Gregg-Adams, VA 23801
Mailing address
2440 Lawrenceville Hwy Ste 200
Decatur, GA 30033-3267
Phone (404) 634-3400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 26283 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687219200000",
"number": "1063660793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2440 LAWRENCEVILLE HWY STE 200",
"city": "DECATUR",
"state": "GA",
"postal_code": "300333267",
"telephone_number": "404-634-3400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "KENNER ARMY HEALTH CLINIC",
"address_2": "700 24TH STREET",
"city": "FORT GREGG-ADAMS",
"state": "VA",
"postal_code": "23801",
"telephone_number": "804-734-9143",
"fax_number": "804-734-9188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZANOV",
"first_name": "MARAT",
"middle_name": "V.",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-06",
"last_updated": "2023-06-20",
"certification_date": "2023-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 26283",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gregg-Adams, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.