Active NPI
Carlyle Bruce
- Clinical Psychologist
- Atlanta, GA
National Provider Identifier
1114291655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY0002627
- Practice address
- 1961 N Druid Hills Rd NE
Atlanta, GA 30329-1842 - Phone
- (404) 315-8333
- NPI assigned
- Mar 1, 2012
- Last updated
- Mar 1, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY0002627 | GA | Primary |
Addresses
Primary practice location
1961 N Druid Hills Rd NE
Atlanta, GA 30329-1842
Mailing address
4708 Elam Forest Dr
Stone Mountain, GA 30083-4929
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY0002627 | GA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thrive Wellness Clinic, LLC | Past | Accepting new patients | |
| Skyland Hi | Past | Accepting new patients | |
| George B. West Mental Health Foundation | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330560000000",
"number": "1114291655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4708 ELAM FOREST DR",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300834929"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1961 N DRUID HILLS RD NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303291842",
"telephone_number": "404-315-8333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUCE",
"first_name": "CARLYLE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-03-01",
"last_updated": "2012-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY0002627",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.