L. Embry Collins, Jr., PHD, P.C.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

PSY 0892 Issued in GA

Legal business name

L. EMBRY COLLINS, JR., PHD, P.C.

Practice address

4530 S Berkeley Lake Rd
Suite B
Norcross, GA 30071-1660

Phone

(770) 446-5642

Fax

(770) 446-5643

NPI assigned

Aug 17, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Lewis Embry Collins Jr., PHDNPI 1235204991

Title

Psychologist

Phone

(770) 446-5642

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Lewis Embry Collins Jr., PH.D.

  • Psychologist
  • Berkeley Lake, GA
  • NPI 1235204991
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1250467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250467200000",
    "number": "1215169883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 S BERKELEY LAKE RD",
            "address_2": "SUITE B",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300711660",
            "telephone_number": "770-446-5642",
            "fax_number": "770-446-5643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 S BERKELEY LAKE RD",
            "address_2": "SUITE B",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300711660",
            "telephone_number": "770-446-5642",
            "fax_number": "770-446-5643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "L. EMBRY COLLINS, JR., PHD, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-17",
        "last_updated": "2009-08-17",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_middle_name": "EMBRY",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "770-446-5642",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "GA",
            "license": "PSY 0892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000546356C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Norcross, GA
• Providers in Norcross, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2009; 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.