Individual provider Active NPI

Linda Klaitz, ED.D

  • Clinical Psychologist
  • Atlanta, GA
National Provider Identifier
1073642385
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY000767 Issued in GA
Practice address
130 Montgomery Ferry Dr NE
Atlanta, GA 30309-2713
Phone
(404) 257-0964
NPI assigned
Mar 4, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY000767 GA Primary

Addresses

Primary practice location

130 Montgomery Ferry Dr NE
Atlanta, GA 30309-2713

Mailing address

130 Montgomery Ferry Dr NE
Atlanta, GA 30309-2713
Phone (404) 257-0964

Other identifiers 1

IdentifierTypeStateIssuer
581568713OtherGATAX ID

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
I20070516000068 GA Practitioner - Clinical Psychologist 5193822799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

Atlanta, GA 30309
Phone (404) 257-0964

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY000767GAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Linda J. Klaitz Ed.D. PC CurrentSince Apr 10, 1997 Accepting new patients

Locations

300 W Wieuca Rd NE
Bldg 2
Atlanta, GA 30342
Phone (404) 255-7929

Organizations & group practices 1

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": "1172966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1073642385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 MONTGOMERY FERRY DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303092713",
            "telephone_number": "404-257-0964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 MONTGOMERY FERRY DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303092713",
            "telephone_number": "404-257-0964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLAITZ",
        "first_name": "LINDA",
        "name_prefix": "Dr.",
        "credential": "ED.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-04",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY000767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "581568713",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.