Health Rejuvenations Consultant, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

004196 Issued in GA

Legal business name

HEALTH REJUVENATIONS CONSULTANT, INC.

Practice address

194 Jonesboro Rd
Suite a-6
Jonesboro, GA 30236-4812

Phone

(404) 731-6107

Fax

(404) 366-9947

NPI assigned

Apr 9, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Doris D'Nin Patillo, PSYD. L.P.C., CACII

Title

Ceo-Psychologist

Phone

(404) 731-6107

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307491200000",
    "number": "1396868824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4588 BOULDERCREST RD",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302943613",
            "telephone_number": "404-731-6107",
            "fax_number": "404-366-9947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "194 JONESBORO RD",
            "address_2": "SUITE A-6",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302364812",
            "telephone_number": "404-731-6107",
            "fax_number": "404-366-9947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH REJUVENATIONS CONSULTANT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2011-06-08",
        "status": "A",
        "authorized_official_last_name": "PATILLO",
        "authorized_official_first_name": "DORIS",
        "authorized_official_middle_name": "D'NIN",
        "authorized_official_title_or_position": "CEO-PSYCHOLOGIST",
        "authorized_official_telephone_number": "404-731-6107",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD. L.P.C., CACII"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "1594",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "004196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP CORPORATION",
            "identifier": "01068080",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; 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.