NPIMap

Organization Active NPI

Georgia Autism Center LLC

  • Clinical Psychologist
  • Peachtree Corners, GA
National Provider Identifier
1376059998
Registry record updated Dec 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY2999 Issued in GA
Legal business name
GEORGIA AUTISM CENTER LLC
Practice address
4046 Wetherburn Way Ste 1
Peachtree Corners, GA 30092-4614
Phone
(770) 696-4384
NPI assigned
Dec 19, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2017

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

Authorized official

Name
Jaymie L Fox, PSY.D.
Title
Owner
Phone
(770) 696-4384

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PSY2999 GA Primary

Addresses

Primary practice location

4046 Wetherburn Way Ste 1
Peachtree Corners, GA 30092-4614

Mailing address

4046 Wetherburn Way Ste 1
Peachtree Corners, GA 30092-4614
Phone (770) 696-4384

Other identifiers 1

IdentifierTypeStateIssuer
380415072CMedicaidGA

Other names 1

  • JAYMIE HELEN LUCKOW FOX SOLE MBR Doing business as

National Provider Directory

National Provider Directory

Locations

4046 Wetherburn Way
Ste 1
Peachtree Corners, GA 30092
Phone (770) 696-4384

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1513641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513641600000",
    "number": "1376059998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4046 WETHERBURN WAY STE 1",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300924614",
            "telephone_number": "770-696-4384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4046 WETHERBURN WAY STE 1",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300924614",
            "telephone_number": "770-696-4384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA AUTISM CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-19",
        "last_updated": "2017-12-19",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "JAYMIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-696-4384",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY2999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "380415072C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JAYMIE HELEN LUCKOW FOX SOLE MBR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peachtree Corners, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2017; 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.