Psychogenesis, Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2075 Issued in GA

Legal business name

PSYCHOGENESIS, INC.

Practice address

519 Broad St
Suite 202
Rome, GA 30161-1734

Phone

(706) 232-5544

Fax

(888) 543-1173

NPI assigned

Dec 24, 2006

Last updated

Dec 3, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Judith Tutin, PH.D.NPI 1265597942

Title

President

Phone

(706) 232-5544

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Judith Tutin, PH.D.

  • Clinical Psychologist
  • Rome, GA
  • NPI 1265597942
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1166918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449100800000",
    "number": "1083779763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 WINDSOR RD SW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301658555",
            "telephone_number": "706-232-5544",
            "fax_number": "888-543-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 BROAD ST",
            "address_2": "SUITE 202",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301611734",
            "telephone_number": "706-232-5544",
            "fax_number": "888-543-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOGENESIS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-24",
        "last_updated": "2015-12-03",
        "status": "A",
        "authorized_official_last_name": "TUTIN",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-232-5544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "2075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000728923A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven W Pruett, M.D.
• Stevanie Pruitt-Bell
• Pruitthealth - Rome, LLC
• Pruitthealth Home Health, Inc. (PruittHealth @ Home - Rome)
• Pruitthealth Hospice, Inc. (PruittHealth Hospice - Rome)
• Psychological Associates of Northwest Georgia, Inc.
• Publix Super Markets Inc (Publix Pharmacy #1403)
• Jolie Alexis Puckett, NP
• Rhonda Kim Puckett
• Marcy McElveen Pugliese, RD

• Clinical Psychologist in Rome, GA
• Providers in Rome, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.