Willie F Ausborn, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2449 Issued in GA

Practice address

4500 Hugh Howell Rd
Suite 740
Tucker, GA 30084-4723

Phone

(770) 938-4616

Fax

(770) 938-4615

NPI assigned

Jan 22, 2007

Last updated

Sep 2, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Ausborn Behavioral Care, PC

  • Clinical Psychologist
  • Atlanta, GA
  • NPI 1114196912
  NPD (past)

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251849600000",
    "number": "1366596025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 HUGH HOWELL RD",
            "address_2": "SUITE 740",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844723",
            "telephone_number": "770-938-4616",
            "fax_number": "770-938-4615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 HUGH HOWELL RD",
            "address_2": "SUITE 740",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844723",
            "telephone_number": "770-938-4616",
            "fax_number": "770-938-4615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AUSBORN",
        "first_name": "WILLIE",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2009-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "2449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000885629A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "001346",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01000298",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CENPATICO",
            "identifier": "000885629A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTHLAKE MEDICAL RESEARC",
            "identifier": "33-1078488",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER",
            "identifier": "A3022",
            "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 Sep 2, 2009; 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.