Affiliated Psychological & Medical Consultants, LLC
Organization Active NPI Psychologist · Gainesville, GA
NPI 1174601348 · NPPES record last updated May 17, 2022
Key facts
- NPI
- 1174601348
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychologist 103T00000X
- Legal business name
- AFFILIATED PSYCHOLOGICAL & MEDICAL CONSULTANTS, LLC
- Practice address
- 200 W Academy Street NW
Suite a
Gainesville, GA 30501-8524 - Phone
- (770) 535-1284
- Fax
- (770) 536-3888
- NPI assigned
- Nov 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Luann B Woods
- Title
- Office Manager
- Phone
- (678) 630-4963
Practitioners 5
-
David S Bailey, ED.D., ABPP
-
Janice R Hughes, PHD
-
Patricia A McCoy, PH.D.
-
William L. Buchanan, PH.D.
-
Robyn J Pichler, PSY.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040604000070 | GA | Part B Supplier - Clinic/Group Practice | 1153303987 |
Receives reassigned benefits from 3 practitioners Practice locations: Gainesville, GA |
National Provider Directory
Locations
200 W Academy St NW
Ste A
Gainesville, GA 30501
Phone (770) 535-1284
200 S Enota Dr NE
Ste 400
Gainesville, GA 30501
Phone (404) 535-1284
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | Yes | ||
| Clinical Psychologist |
103TC0700X |
Addresses
Primary practice location
200 W Academy Street NW
Suite a
Gainesville, GA 30501-8524
Mailing address
200 W Academy NW
Ste a
Gainesville, GA 30501-8524
Phone (770) 535-1284
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 55001088A | Medicaid | GA |
Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.