NPIMap

Organization Active NPI

325 MDG

  • Psychologist
  • Tyndall Afb, FL
National Provider Identifier
1568436962
Registry record updated Jun 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY5848 Issued in FL
Legal business name
325 MDG
Practice address
325 MDG BLDG
1305 Suwannee Ave
Tyndall Afb, FL 32403
Phone
(850) 283-7511
Fax
(850) 283-7721
NPI assigned
Feb 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2008

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

Authorized official

Name
Dr. George Nicholas Jr.
Title
325 MDG Commander
Phone
(850) 283-7515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X PY5848 FL Primary

Addresses

Primary practice location

325 MDG BLDG
1305 Suwannee Ave
Tyndall Afb, FL 32403

Mailing address

2405 Maple CT
Panama City, FL 32404-3047
Phone (850) 283-7511

National Provider Directory

National Provider Directory
Tax ID family
325 MDG4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1568436962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2405 MAPLE CT",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324043047",
            "telephone_number": "850-283-7511",
            "fax_number": "850-283-7721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 MDG BLDG",
            "address_2": "1305 SUWANNEE AVE",
            "city": "TYNDALL AFB",
            "state": "FL",
            "postal_code": "32403",
            "telephone_number": "850-283-7511",
            "fax_number": "850-283-7721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "325 MDG",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-14",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "NICHOLAS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "325 MDG COMMANDER",
        "authorized_official_telephone_number": "850-283-7515",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY5848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyndall Afb, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; 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.