Virginia L Goetsch, PH.D., LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2269 Issued in GA

Legal business name

VIRGINIA L GOETSCH, PH.D., LLC

Practice address

775 Commerce Dr
Suite 903
Decatur, GA 30030-2620

Phone

(770) 301-3578

Fax

(404) 638-5293

NPI assigned

Aug 31, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Virginia L Goetsch, PH.D.

Title

President

Phone

(770) 301-3578

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Virginia L. Goetsch, Ph.D. Doing business as

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

{
    "created_epoch": "1346371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351728000000",
    "number": "1407105703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5282 HICKORY WALK TER SW",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300944757",
            "telephone_number": "770-301-3578",
            "fax_number": "404-638-5293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 COMMERCE DR",
            "address_2": "SUITE 903",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302620",
            "telephone_number": "770-301-3578",
            "fax_number": "404-638-5293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA L GOETSCH, PH.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-31",
        "last_updated": "2012-11-01",
        "status": "A",
        "authorized_official_last_name": "GOETSCH",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-301-3578",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "2269",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11511070",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000820817C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Virginia L. Goetsch, Ph.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Psychologist in Decatur, GA
• Providers in Decatur, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2012; 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.