Psychological Affiliates

Primary specialty

PsychologistTaxonomy code 103T00000X

License

000669 GA Issued in GA

Legal business name

PSYCHOLOGICAL AFFILIATES

Practice address

122 Cherry St NE
Marietta, GA 30060-7206

Phone

(770) 427-2911

NPI assigned

Jan 9, 2008

Last updated

Jan 9, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jack Holland Grisham, PH.D.NPI 1376692061

Title

President

Phone

(770) 427-2911

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jack Holland Grisham, PH.D.

  • Psychologist
  • Marietta, GA
  • NPI 1376692061
  Authorized official Same address or phone

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

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199836800000",
    "number": "1376728394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 CHERRY ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607206",
            "telephone_number": "770-427-2911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 CHERRY ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607206",
            "telephone_number": "770-427-2911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL AFFILIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-09",
        "last_updated": "2008-01-09",
        "status": "A",
        "authorized_official_last_name": "GRISHAM",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "HOLLAND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-427-2911",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "GA",
            "license": "000669 GA",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "001135 GA",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "GA CSW003681",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Marietta, GA
• Providers in Marietta, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; 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.