NPIMap

Organization Active NPI

Sweetwater Psychological Associates, LLC

  • Clinical Psychologist
  • Marietta, GA
National Provider Identifier
1114085743
Registry record updated Aug 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY001373 Issued in GA
Legal business name
SWEETWATER PSYCHOLOGICAL ASSOCIATES, LLC
Practice address
2625 Sandy Plains Rd Ste 202
Secondary Location
Marietta, GA 30066-4291
Phone
(770) 732-0983
Fax
(770) 732-1283
NPI assigned
Dec 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2007

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

Authorized official

Name
Dr. David Clyde Martin, PH.D.
Title
Owner/Partner
Phone
(770) 732-0982

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PSY001373 GA Primary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PSY001157 GA
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X CSW000729 GA

Addresses

Primary practice location

2625 Sandy Plains Rd Ste 202
Secondary Location
Marietta, GA 30066-4291

Mailing address

PO Box 1078
Lithia Springs, GA 30122-1078
Phone (770) 732-0982

National Provider Directory

National Provider Directory

Locations

2625 Sandy Plains Rd
Ste 202
Marietta, GA 30066
Phone (770) 732-0982

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186704000000",
    "number": "1114085743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1078",
            "city": "LITHIA SPRINGS",
            "state": "GA",
            "postal_code": "301221078",
            "telephone_number": "770-732-0982",
            "fax_number": "770-732-1283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 SANDY PLAINS RD STE 202",
            "address_2": "SECONDARY LOCATION",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300664291",
            "telephone_number": "770-732-0983",
            "fax_number": "770-732-1283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SWEETWATER PSYCHOLOGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2007-08-10",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "CLYDE",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "770-732-0982",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY001373",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY001157",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW000729",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2007; 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.