Active NPI
Pegah Moghaddam, PSY. D
- Psychologist
- Atlanta, GA
National Provider Identifier
1376841296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 4536 Barclay Dr
Suite a
Atlanta, GA 30338-7145 - Phone
- (770) 458-8711
- Fax
- (770) 458-8640
- NPI assigned
- Mar 1, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
4536 Barclay Dr
Suite a
Atlanta, GA 30338-7145
Mailing address
4536 Barclay Dr
Suite a
Atlanta, GA 30338-7145
Phone (770) 458-8711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 13, 2024 through Feb 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlanta Center for Eating Disorders | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Atlanta, GA
- NPI 1154442903
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299110400000",
"number": "1376841296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4536 BARCLAY DR",
"address_2": "SUITE A",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303387145",
"telephone_number": "770-458-8711",
"fax_number": "770-458-8640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4536 BARCLAY DR",
"address_2": "SUITE A",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303387145",
"telephone_number": "770-458-8711",
"fax_number": "770-458-8640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOGHADDAM",
"first_name": "PEGAH",
"credential": "PSY. D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-03-01",
"last_updated": "2011-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2011; 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.