Paul W Schenk PSYD PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

663 Issued in GA

Legal business name

PAUL W SCHENK PSYD PC

Practice address

3589 Habersham at Northlake
Tucker, GA 30084-4009

Phone

(770) 939-4473

Fax

(770) 939-0033

NPI assigned

May 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Paul W. Schenk, PSY.D.NPI 1831171065

Title

President

Phone

(770) 939-4473

Specialties & licenses 4

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.

• Paul W Schenk, PSY.D.

  • Psychologist
  • Tucker, GA
  • NPI 1831171065

  Clinical

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321401600000",
    "number": "1225248362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3589 HABERSHAM AT NORTHLAKE",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844009",
            "telephone_number": "770-939-4473",
            "fax_number": "770-939-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3589 HABERSHAM AT NORTHLAKE",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844009",
            "telephone_number": "770-939-4473",
            "fax_number": "770-939-0033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL W SCHENK PSYD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2011-11-16",
        "status": "A",
        "authorized_official_last_name": "SCHENK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-939-4473",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "GA",
            "license": "663",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "663",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "GA",
            "license": "663",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": "GA",
            "license": "663",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000187954A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Tucker, GA
• Providers in Tucker, 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 16, 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.