Georgia Kelly-Williams

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

404380 Issued in NY

Practice address

52 Tiber Ave
Deer Park, NY 11729-7012

Phone

(631) 404-8843

NPI assigned

Aug 24, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

CS Medical Associates, PC 63 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gkellywilliams@victoryrecovery.medentdirect.com

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.

• CS Medical Associates, P.C.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Farmingville, NY
  • NPI 1992210231

  NY

  Medicare reassignment Care Compare group NPD
• Supportive Care Psychology of Ny PC

  • Clinical Psychologist
  • Howell, NJ
  • NPI 1104315068

  NY

  Medicare reassignment NPD
• CS Medical Associates, P.C.

  • Counselor
  • Amityville, NY
  • NPI 1790653236
  NPD
• Shore to Shore Psychiatry P.C.

  • Psychiatry Physician
  • Port Jefferson Station, NY
  • NPI 1558129932
  NPD (past)

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

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1104545037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 TIBER AVE",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117297012",
            "telephone_number": "631-404-8843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 TIBER AVE",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117297012",
            "telephone_number": "631-404-8843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY-WILLIAMS",
        "first_name": "GEORGIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-24",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "404380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Saransh Kapoor
• Catty Kapsoli
• Laneya Katzman
• Simranjit Kaur
• Ellen Keller, PSY.D.
• Thomas Donald Kempton, PH.D.
• Gerard Kennedy
• Kenneth a. Paticoff, DDS, PC
• Kevin a Henner,DMD,PC
• Cyril Khan Jr., COTA

• All providers in Deer Park, NY
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.