NPIMap

Organization Active NPI

Northside Psychological Services, Inc.

  • Clinical Psychologist
  • Marietta, GA
National Provider Identifier
1184997439
Registry record updated Feb 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
NORTHSIDE PSYCHOLOGICAL SERVICES, INC.
Practice address
1395 S Marietta Pkwy SE
BLDG. 400, Suite 112
Marietta, GA 30067-4440
Phone
(770) 667-3877
Fax
(770) 667-3879
NPI assigned
Feb 16, 2012
Last updated
Feb 16, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2012

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

Authorized official

Name
Emily Redman
Title
Business Director
Phone
(678) 367-7515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X NU Primary

Addresses

Primary practice location

1395 S Marietta Pkwy SE
BLDG. 400, Suite 112
Marietta, GA 30067-4440

Mailing address

PO Box 250
Alpharetta, GA 30009-0250
Phone (770) 667-3877

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 29

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.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1329350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1184997439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 250",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300090250",
            "telephone_number": "770-667-3877",
            "fax_number": "770-667-3879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1395 S MARIETTA PKWY SE",
            "address_2": "BLDG. 400, SUITE 112",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300674440",
            "telephone_number": "770-667-3877",
            "fax_number": "770-667-3879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE PSYCHOLOGICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-16",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "REDMAN",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "BUSINESS DIRECTOR",
        "authorized_official_telephone_number": "678-367-7515"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 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.

Verify at the official NPI Registry.