Active NPI
Alfred Bates Canon, LPC
- Professional Counselor
- Atlanta, GA
National Provider Identifier
1619401585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 002599
- Practice address
- 2849B Henderson Mill Rd
Atlanta, GA 30341-5772 - Phone
- (678) 465-7537
- NPI assigned
- Apr 17, 2017
- Last updated
- Apr 17, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 002599 | GA | Primary |
Addresses
Primary practice location
2849B Henderson Mill Rd
Atlanta, GA 30341-5772
Mailing address
3084 Northbrook Dr
Atlanta, GA 30341-4631
Phone (678) 465-7537
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 18, 2025 through May 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002599 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492387200000",
"number": "1619401585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3084 NORTHBROOK DR",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303414631",
"telephone_number": "678-465-7537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2849B HENDERSON MILL RD",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303415772",
"telephone_number": "678-465-7537"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANON",
"first_name": "ALFRED",
"middle_name": "BATES",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-04-17",
"last_updated": "2017-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "002599",
"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 Apr 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.