Individual provider Active NPI

Adam McTighe, PSY.D., MBA

  • Psychologist
  • Atlanta, GA
National Provider Identifier
1578964979
Registry record updated Sep 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
4000 Issued in GA
Practice address
3545 Broad St Unit 660156
Atlanta, GA 30366-2123
Phone
(404) 275-4604
NPI assigned
Sep 5, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 17 FL
Psychologist 103T00000X 18978 PA
Student in an Organized Health Care Education/Training Program 390200000X
Psychologist 103T00000X 4000 GA Primary

Addresses

Primary practice location

3545 Broad St Unit 660156
Atlanta, GA 30366-2123

Mailing address

3545 Broad St Unit 660156
Atlanta, GA 30366-2123
Phone (404) 275-4604

Other practice location 1

747 52nd St
Oakland, CA 94609-1809
Phone (510) 428-3885

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration

State licenses

LicenseStateTypeSpecialty
17FLMDPsychologist
18978PAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mind Restoration, LLC Psychologist CurrentSince Sep 10, 2023 Accepting new patients

Locations

3545 Broad St
Unit 660156
Atlanta, GA 30366
Phone (404) 275-4604

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.

NPI Registry JSON

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

{
    "created_epoch": "1409875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694131200000",
    "number": "1578964979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3545 BROAD ST UNIT 660156",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303662123",
            "telephone_number": "404-275-4604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3545 BROAD ST UNIT 660156",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303662123",
            "telephone_number": "404-275-4604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "747 52nd St",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946091809",
            "country_code": "US",
            "telephone_number": "510-428-3885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCTIGHE",
        "first_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "PSY.D., MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-05",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "17",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "18978",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "4000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; 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.