Individual provider Active NPI

Paul Andrew Walters III, PH.D.

  • Clinical Psychologist
  • Augusta, GA
National Provider Identifier
1477546190
Registry record updated Nov 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY002120 Issued in GA
Practice address
3643 Walton Way Ext
Augusta, GA 30909-4507
Phone
(706) 729-9595
Fax
(706) 729-0332
NPI assigned
Aug 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY002120 GA Primary

Addresses

Primary practice location

3643 Walton Way Ext
Augusta, GA 30909-4507

Mailing address

3333 Walton Way
Augusta, GA 30909-4529
Phone (706) 729-9595

Other identifiers 1

IdentifierTypeStateIssuer
000819816AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120627000513 GA Practitioner - Clinical Psychologist 1254598394 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Augusta Center for Psychological Services, PCGroup PAC ID 0244497378, 4 clinicians

Practice addresses (Care Compare)

3643 Walton Way Extension
Augusta, GA 30909-4507
Phone (706) 729-9595

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2120GAMDInternist Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Augusta Center for Psychological Services, PC CurrentSince Feb 4, 1999 Accepting new patients
Paradigm Health Services, Inc Past Accepting new patients

Locations

3643 Walton Way Ext
Augusta, GA 30909
Phone (706) 364-1404

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1125273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320710400000",
    "number": "1477546190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 WALTON WAY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309094529",
            "telephone_number": "706-729-9595",
            "fax_number": "706-729-0332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3643 WALTON WAY EXT",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309094507",
            "telephone_number": "706-729-9595",
            "fax_number": "706-729-0332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "PAUL",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-29",
        "last_updated": "2011-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY002120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000819816A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.