NPIMap

Organization Active NPI

Creative Care Concepts, Inc.

  • Psychiatric/Mental Health Nurse Practitioner
  • Jonesboro, GA
National Provider Identifier
1144273608
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
CREATIVE CARE CONCEPTS, INC.
Practice address
1943 Saybrook CT
Jonesboro, GA 30236-2681
Phone
(770) 478-6091
Fax
(770) 478-6875
NPI assigned
May 18, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Justin M Waits
Title
Business Manager
Phone
(770) 478-6091

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

1943 Saybrook CT
Jonesboro, GA 30236-2681

Mailing address

1943 Saybrook CT
Jonesboro, GA 30236-2681
Phone (770) 478-6091

National Provider Directory

National Provider Directory

Locations

3850 Safehaven Dr
Lawrenceville, GA 30044
Phone (770) 656-1093

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144273608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1943 SAYBROOK CT",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302362681",
            "telephone_number": "770-478-6091",
            "fax_number": "770-478-6875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1943 SAYBROOK CT",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302362681",
            "telephone_number": "770-478-6091",
            "fax_number": "770-478-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE CARE CONCEPTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAITS",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "770-478-6091",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, GA

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.