Active NPI
Linda Vitacco
- Clinical Psychologist
- Augusta, GA
National Provider Identifier
1396176145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY003560
- Practice address
- 3405 Mike Padgett Hwy
Attention Patient Accounts
Augusta, GA 30906-3815 - Phone
- (706) 792-7026
- Fax
- (706) 792-7314
- NPI assigned
- Dec 4, 2013
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY003560 | GA | Primary |
Addresses
Primary practice location
3405 Mike Padgett Hwy
Attention Patient Accounts
Augusta, GA 30906-3815
Mailing address
3405 Mike Padgett Hwy
Attention Patient Accounts
Augusta, GA 30906-3815
Phone (706) 792-7026
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY003560 | GA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386115200000",
"number": "1396176145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3405 MIKE PADGETT HWY",
"address_2": "ATTENTION PATIENT ACCOUNTS",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309063815",
"telephone_number": "706-792-7026",
"fax_number": "706-792-7314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3405 MIKE PADGETT HWY",
"address_2": "ATTENTION PATIENT ACCOUNTS",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309063815",
"telephone_number": "706-792-7026",
"fax_number": "706-792-7314"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VITACCO",
"first_name": "LINDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-04",
"last_updated": "2013-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY003560",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.