John Azar-Dickens, PH.D.,PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

002459 Issued in GA

Legal business name

JOHN AZAR-DICKENS, PH.D.,PC

Practice address

109 John Maddox Dr NW
Rome, GA 30165-1451

Phone

(706) 232-6743

NPI assigned

Jun 29, 2010

Last updated

Jun 29, 2010By 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. John Azar-Dickens, PH.D.NPI 1104984103

Title

Licensed Psychologist

Phone

(706) 234-0659

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• John Azar-Dickens, PH.D.

  • Clinical Psychologist
  • Rome, GA
  • NPI 1104984103
  Authorized official Same address or phone

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

{
    "created_epoch": "1277769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277769600000",
    "number": "1093026601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1008",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301621008",
            "telephone_number": "706-232-6743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 JOHN MADDOX DR NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651451",
            "telephone_number": "706-232-6743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN AZAR-DICKENS, PH.D.,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-29",
        "last_updated": "2010-06-29",
        "status": "A",
        "authorized_official_last_name": "AZAR-DICKENS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "706-234-0659",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "002459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00895837J",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Chase Jessie, MD
• Mark A Jester, MD
• Phyllis J Jeter, LCSW
• Jill Marie Jewett, FNP-C
• Stacey E Johlman, SP
• John J. Beninato, D.D.S., P.C.
• John Marshall Jenkins PHD LLC
• Alexis Johnson, CRNA
• Chandler Elizabeth Johnson, MD
• Cody Johnson

• 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 Jun 29, 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.