NPIMap

Organization Active NPI

Georgia TRD Clinic, LLC

  • Psychiatry Physician
  • Watkinsville, GA
National Provider Identifier
1376222075
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
GEORGIA TRD CLINIC, LLC
Practice address
1361 Jennings Mill Rd Ste 201
Watkinsville, GA 30677-7292
Phone
(706) 316-1908
Fax
(706) 316-2062
NPI assigned
Jul 12, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Authorized official

Name
Dr. Thomas Wayne McCormack Jr., MDNPI 1740298728
Title
Ceo
Phone
(706) 316-1908

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

1361 Jennings Mill Rd Ste 201
Watkinsville, GA 30677-7292

Mailing address

1361 Jennings Mill Rd Ste 201
Watkinsville, GA 30677-7292
Phone (706) 316-1908

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1689120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1376222075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1361 JENNINGS MILL RD STE 201",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777292",
            "telephone_number": "706-316-1908",
            "fax_number": "706-316-2062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1361 JENNINGS MILL RD STE 201",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777292",
            "telephone_number": "706-316-1908",
            "fax_number": "706-316-2062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA TRD CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-12",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "MCCORMACK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-316-1908",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watkinsville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.