Theodore M Goetz PHD PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

698 Issued in GA

Legal business name

THEODORE M GOETZ PHD PC

Practice address

1751 S Lumpkin St
Athens, GA 30606-4740

Phone

(706) 548-9441

NPI assigned

Nov 28, 2011

Last updated

Nov 28, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Theodore M Goetz, PHDNPI 1669463766

Title

Psychologist

Phone

(706) 548-9441

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

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.

• Theodore Michael Goetz, PH.D.

  • Clinical Psychologist
  • Athens, GA
  • NPI 1669463766
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1322438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1184991705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1751 S LUMPKIN ST",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306064740",
            "telephone_number": "706-548-9441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 S LUMPKIN ST",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306064740",
            "telephone_number": "706-548-9441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE M GOETZ PHD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-28",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "GOETZ",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "706-548-9441",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Athens, GA
• Providers in Athens, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; 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.