Active NPI
Sir Allen Pegues
- Professional Counselor
- Morrow, GA
National Provider Identifier
1447778410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC008654
- Practice address
- 1333 Mount Zion Rd
Morrow, GA 30260-2357 - Phone
- (770) 882-5895
- NPI assigned
- Aug 30, 2017
- Last updated
- Sep 13, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LPC008654 | GA | |
| Mental Health Counselor | 101YM0800X | LPC008654 | GA | |
| Professional Counselor | 101YP2500X | LPC008654 | GA | Primary |
Addresses
Primary practice location
1333 Mount Zion Rd
Morrow, GA 30260-2357
Mailing address
1333 Mount Zion Rd
Morrow, GA 30260-2357
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003191850A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC008654 | GA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Creating a Difference | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Morrow, GA
- NPI 1952859829
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505260800000",
"number": "1447778410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1333 MOUNT ZION RD",
"city": "MORROW",
"state": "GA",
"postal_code": "302602357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1333 MOUNT ZION RD",
"city": "MORROW",
"state": "GA",
"postal_code": "302602357",
"telephone_number": "770-882-5895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEGUES",
"first_name": "SIR ALLEN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-08-30",
"last_updated": "2017-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "GA",
"license": "LPC008654",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "LPC008654",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC008654",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003191850A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Morrow, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.