Individual provider Active NPI

Hamid Mirsalimi, PH.D.

  • Clinical Psychologist
  • Atlanta, GA
National Provider Identifier
1205041100
Registry record updated Oct 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY002432 Issued in GA
Practice address
1776 Century Blvd NE
Suite a
Atlanta, GA 30345-3397
Phone
(404) 579-1987
Fax
(770) 643-3944
NPI assigned
May 14, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY002432 GA Primary

Addresses

Primary practice location

1776 Century Blvd NE
Suite a
Atlanta, GA 30345-3397

Mailing address

12 Norcross St
Suite 200C
Roswell, GA 30075-7409
Phone (404) 579-1987

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100421000794 GA Practitioner - Psychologist Billing Independently 9335276435 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

981 Canton St
Suite 200C
Roswell, GA 30075-4240
Phone (404) 579-1987

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY002432GAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Charting Your Course, LLC Clinical CurrentSince Oct 20, 2004 Accepting new patients
Judy & Bruce Pemberton, LLC Clinical Past Accepting new patients

Locations

1776 Century Blvd NE
Ste A
Atlanta, GA 30345
Phone (404) 579-1987

1784 Century Blvd NE
Ste A
Atlanta, GA 30345
Phone (402) 370-6778

2940 Johnson Ferry Rd
Ste B279
Marietta, GA 30062

12 Norcross St
Ste 200C
Roswell, GA 30075

981 Canton St
Ste 200C
Roswell, GA 30075
Phone (404) 579-1987

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286409600000",
    "number": "1205041100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 NORCROSS ST",
            "address_2": "SUITE 200C",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300757409",
            "telephone_number": "404-579-1987",
            "fax_number": "770-643-3944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1776 CENTURY BLVD NE",
            "address_2": "SUITE A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303453397",
            "telephone_number": "404-579-1987",
            "fax_number": "770-643-3944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRSALIMI",
        "first_name": "HAMID",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2010-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY002432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.