Psychiatry and Psychological Associates LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY002603 Issued in GA

Legal business name

PSYCHIATRY AND PSYCHOLOGICAL ASSOCIATES LLC

Practice address

539 Green St NW
Gainesville, GA 30501-3313

Phone

(770) 718-9790

Fax

(770) 718-5531

NPI assigned

Aug 9, 2006

Organization subpart

No

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

Authorized official

Name

Mark L King, PH.D.

Title

Owner

Phone

(770) 718-9790

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carol H Taylor, LCSW

  • Clinical Social Worker
  • Sugar Hill, GA
  • NPI 1699019703
  Medicare reassignment NPD
• Susan Rachel Berel, PH.D.

  • Clinical Psychologist
  • Suwanee, GA
  • NPI 1194741306
  NPD (past)
• Daniel D Eisenman, PH.D.

  • Clinical Psychologist
  • Gainesville, GA
  • NPI 1376757856
  NPD (past)
• Amelia Sika Mathew, MD

  • Psychiatry Physician
  • Gainesville, GA
  • NPI 1376562488
  NPD (past)
• Polina P Shvarts, M.D.

  • Psychiatry Physician
  • Gainesville, GA
  • NPI 1023113552
  NPD (past)
• Chassidy M Stanley, LCSW

  • Clinical Social Worker
  • Gainesville, GA
  • NPI 1477564367
  NPD (past)
• Cynthia Goodwin Womack, DHS, MN.LMFT,CNS/PMH

  • Marriage & Family Therapist
  • Greensboro, GA
  • NPI 1235345794
  NPD (past)
• Mimi Yilma, M.D.

  • Psychologist
  • Baltimore, MD
  • NPI 1699963298
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124038187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "539 GREEN ST NW",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013313",
            "telephone_number": "770-718-9790",
            "fax_number": "770-718-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "539 GREEN ST NW",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013313",
            "telephone_number": "770-718-9790",
            "fax_number": "770-718-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHIATRY AND PSYCHOLOGICAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-718-9790",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY002603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Pruitt, PA
• Kristen Agnew Pruitt, M.S, PT
• Lisa Carol Pruitt, LPN
• Pruitthealth Home Health, Inc. (PruittHealth @ Home - Gainesville)
• Pruitthealth Hospice, Inc. (PruittHealth Hospice - Gainesville)
• Psychotherapy and Assessment Services
• PT Med (Bracit)
• Publix Super Markets Inc (Publix Pharmacy #1110)
• Publix Super Markets, Inc. (Publix Pharmacy #2045)
• Publix Super Markets, Inc. (Publix Pharmacy #2006)

• Psychologist in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.