Psychological Consultants of Georgia PC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PSYCHOLOGICAL CONSULTANTS OF GEORGIA PC

Practice address

5284 Floyd Rd SW Unit 1216
Mableton, GA 30126-6109

Phone

(404) 936-2346

NPI assigned

May 29, 2024

Last updated

May 29, 2024By 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. Carmine Costello, DONPI 1073227054

Title

President

Phone

(404) 936-2346

Specialties & licenses 2

Addresses

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.

• Carmine Costello, PHD

  • Forensic Psychologist
  • Jefferson, GA
  • NPI 1073227054
  NPD Authorized official

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

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716940800000",
    "number": "1093555989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5284 FLOYD RD SW UNIT 1216",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301266109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5284 FLOYD RD SW UNIT 1216",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301266109",
            "telephone_number": "404-936-2346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL CONSULTANTS OF GEORGIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-29",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "CARMINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-936-2346",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Mableton, GA
• Providers in Mableton, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; 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.