Active NPI
Lynda Brooks Bolton, PH.D.
- Psychologist
- Griffin, GA
National Provider Identifier
1386705176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY000828
- Practice address
- 2914 Macon Road
Griffin, GA 30224 - Phone
- (770) 229-9324
- Fax
- (770) 229-9796
- NPI assigned
- Dec 13, 2006
- 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 | PSY000828 | GA | Primary |
Addresses
Primary practice location
2914 Macon Road
Griffin, GA 30224
Mailing address
PO Box 450
Orchard Hill, GA 30266-0450
Phone (770) 229-9324
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00261027A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY000828 | GA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1386705176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 450",
"city": "ORCHARD HILL",
"state": "GA",
"postal_code": "302660450",
"telephone_number": "770-229-9324",
"fax_number": "770-229-9796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2914 MACON ROAD",
"city": "GRIFFIN",
"state": "GA",
"postal_code": "30224",
"telephone_number": "770-229-9324",
"fax_number": "770-229-9796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLTON",
"first_name": "LYNDA",
"middle_name": "BROOKS",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-13",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "PSY000828",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00261027A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Griffin, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.