John Russell Atkinson, MS
Individual provider Active NPI Clinical Psychologist · Vienna, WV
NPI 1104003524 · NPPES record last updated Jan 28, 2008
Key facts
- NPI
- 1104003524
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 309 (WV)
- Practice address
- 1007 38TH St
Vienna, WV 26105-2741 - Phone
- (304) 295-9243
- Fax
- (304) 428-4500
- NPI assigned
- Jan 28, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 309 | WV | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 309 | WV | Yes |
Addresses
Primary practice location
1007 38TH St
Vienna, WV 26105-2741
Mailing address
1007 38TH St.
Vienna, WV 26105-2741
Phone (304) 295-9243
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0165376000 | Medicaid | WV |
Other providers in Vienna, WV
- Patricia Arnett
- Brittany Arthur
- Arvilla Caring Hands, LLC
- Arvilla Caring Hands, LLC
- Athena Health Center, LLC
- Tammy Backus
- Seyoum Daffo Bage
- Patricia Kwartengmaa Baidoo
- Jordan Bailey
- Markeylia Bailey
All providers in Vienna, WV · Clinical Psychologist in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.