Active NPI
Robert Lewis Bozard Jr.
- Professional Counselor
- Decatur, GA
National Provider Identifier
1275805608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- APC003280
- Practice address
- 1814 Clairmont Rd
Decatur, GA 30033-3405 - Phone
- (404) 636-1457
- Fax
- (404) 636-7449
- NPI assigned
- Feb 1, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | APC003280 | GA | Primary |
Addresses
Primary practice location
1814 Clairmont Rd
Decatur, GA 30033-3405
Mailing address
1814 Clairmont Rd
Decatur, GA 30033-3405
Phone (404) 636-1457
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 26, 2024 through Jan 26, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APC003280 | GA | MD | Professional Counselor |
| 13873 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328054400000",
"number": "1275805608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1814 CLAIRMONT RD",
"city": "DECATUR",
"state": "GA",
"postal_code": "300333405",
"telephone_number": "404-636-1457",
"fax_number": "404-636-7449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1814 CLAIRMONT RD",
"city": "DECATUR",
"state": "GA",
"postal_code": "300333405",
"telephone_number": "404-636-1457",
"fax_number": "404-636-7449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOZARD",
"first_name": "ROBERT",
"middle_name": "LEWIS",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-02-01",
"last_updated": "2012-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "APC003280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.