Active NPI
Larry E Daniels, PSY.D
- Psychologist
- Augusta, GA
National Provider Identifier
1104849215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 831
- Practice address
- 2301 Wrightsboro Rd
Augusta, GA 30904-6219 - Phone
- (706) 733-7029
- Fax
- (706) 733-1376
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY002223 | GA | |
| Psychologist | 103T00000X | 831 | SC | Primary |
| Cognitive & Behavioral Psychologist | 103TB0200X | PSY002223 | GA | |
| Family Psychologist | 103TF0000X | PSY002223 | GA | |
| Psychologist | 103T00000X | PSY002223 | GA |
Addresses
Primary practice location
2301 Wrightsboro Rd
Augusta, GA 30904-6219
Mailing address
2301 Wrightsboro Rd
Augusta, GA 30904-6219
Phone (706) 733-7029
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS0268 | Medicaid | SC | |
| 000801094C | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY002223 | GA | MD | Psychologist |
| 831 | SC | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259625600000",
"number": "1104849215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2301 WRIGHTSBORO RD",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309046219",
"telephone_number": "706-733-7029",
"fax_number": "706-733-1376"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2301 WRIGHTSBORO RD",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309046219",
"telephone_number": "706-733-7029",
"fax_number": "706-733-1376"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANIELS",
"first_name": "LARRY",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2009-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY002223",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "SC",
"license": "831",
"primary": true
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "GA",
"license": "PSY002223",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "GA",
"license": "PSY002223",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "PSY002223",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PS0268",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000801094C",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.