Individual provider Active NPI

Linda Starling Lewis, PH D

  • Psychologist
  • Fayetteville, GA
National Provider Identifier
1609944552
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2388 Issued in GA
Practice address
115 Habersham Dr
Fayetteville, GA 30214
Phone
(770) 461-9944
Fax
(770) 461-9779
NPI assigned
Nov 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2388 GA Primary

Addresses

Primary practice location

115 Habersham Dr
Fayetteville, GA 30214

Mailing address

115 Habersham Dr
Fayetteville, GA 30214
Phone (770) 461-9944

Other identifiers 1

IdentifierTypeStateIssuer
00883187AMedicaidGA

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
I20060417000026 GA Practitioner - Clinical Psychologist 6507875739 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2388GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Psychologist CurrentSince May 23, 2023 Accepting new patients
A New Start Counseling Center Inc Psychologist CurrentSince Sep 1, 2000 Accepting new patients
Accordia Counseling Solutions Past Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

715 Peachtree St NE
Ste 100
Atlanta, GA 30308
Phone (202) 972-4964

115 Habersham Dr
Fayetteville, GA 30214
Phone (770) 461-9944

Organizations & group practices 3

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": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609944552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 HABERSHAM DR",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "30214",
            "telephone_number": "770-461-9944",
            "fax_number": "770-461-9779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 HABERSHAM DR",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "30214",
            "telephone_number": "770-461-9944",
            "fax_number": "770-461-9779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "LINDA",
        "middle_name": "STARLING",
        "credential": "PH D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "2388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00883187A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

Verify at the official NPI Registry.