Active NPI
Teejay Grant Tripp, DO
- Psychiatry Physician
- Sandy Springs, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 98820
- Practice address
- 990 Hammond Dr Ste 600
Sandy Springs, GA 30328-5510 - Phone
- (678) 861-1832
- Fax
- (678) 585-2259
- NPI assigned
- Dec 30, 2009
- Last updated
- Sep 4, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 11583541-1204 | UT | |
| Psychiatry Physician | 2084P0800X | 005662 | AZ | |
| Psychiatry Physician | 2084P0800X | 100970 | AK | |
| Psychiatry Physician | 2084P0800X | T8445 | TX | |
| Psychiatry Physician | 2084P0800X | 98820 | GA | Primary |
| Psychiatry Physician | 2084P0800X | CDR.0000580 | CO | |
| Psychiatry Physician | 2084P0800X | OS19270 | FL | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 005662 | AZ | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | CDR.0000580 | CO | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | CL0066 | NV | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | T8445 | TX | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 98820 | GA | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 19551 | NH | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | OS19270 | FL | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 11583541-1234 | UT |
Addresses
Primary practice location
990 Hammond Dr Ste 600
Sandy Springs, GA 30328-5510
Mailing address
990 Hammond Dr Ste 600
Atlanta, GA 30328-5510
Other practice location 1
6071 E Woodmen Rd Ste 135
Colorado Springs, CO 80923-2608
Phone (720) 712-0306
Other practice location 2
841 Prudential Dr Ste 1100
Jacksonville, FL 32207-8352
Phone (904) 902-4408
Other practice location 3
500 Discovery Pkwy Ste 350
Superior, CO 80027-8639
Phone (720) 712-0306
Other practice location 4
9399 Crown Crest Blvd Ste 401
Parker, CO 80138-8540
Phone (720) 712-0306
Other practice location 5
1860 N 95th Ln Ste 300
Phoenix, AZ 85037-5074
Phone (480) 626-7584
Other practice location 6
9102 Southpark Center Loop Ste 120
Orlando, FL 32819-8626
Phone (689) 282-6774
Other practice location 7
145 W 200 N Ste 600
Provo, UT 84601-3016
Phone (801) 821-2781
Other practice location 8
18615 Tuscany Stone Ste 250
San Antonio, TX 78258-3504
Phone (726) 207-5519
Other practice location 9
425 S Cherry St Fl 10
Denver, CO 80246-1226
Phone (720) 712-0306
Other practice location 10
255 S Routt St Ste 250
Lakewood, CO 80228-2214
Phone (720) 712-0306
Other practice location 11
6500 West Fwy Ste 700
Fort Worth, TX 76116-2180
Phone (817) 527-8621
Other practice location 12
1501 N Gilbert Rd Ste 206
Gilbert, AZ 85234-2394
Phone (480) 626-7584
Other practice location 13
3300 N Triumph Blvd Ste 500
Lehi, UT 84043-6475
Phone (801) 821-2781
Other practice location 14
255 Primera Blvd Ste 520
Lake Mary, FL 32746-2158
Phone (689) 282-6774
Other practice location 15
44084 Riverside Pkwy Ste 300
Leesburg, VA 20176-5102
Phone (571) 534-3900
Other practice location 16
2221 Lakeside Blvd Ste 1225
Richardson, TX 75082-4370
Phone (817) 527-8621
Other practice location 17
2695 Rocky Mountain Ave Ste 260
Loveland, CO 80538-9075
Phone (720) 712-0306
Other practice location 18
7455 W Washington Ave Ste 420
Las Vegas, NV 89128-4352
Phone (725) 235-7883
Other practice location 19
3800 Gaylord Pkwy Ste 1100
Frisco, TX 75034-9416
Phone (817) 527-8621
Other practice location 20
4545 E Chandler Blvd Ste 308
Phoenix, AZ 85048-7646
Phone (480) 626-7584
Other practice location 21
2355 E Camelback Rd Ste 625
Phoenix, AZ 85016-3458
Phone (480) 626-7584
Other practice location 22
9400 Southpark Center Loop Ste 450
Orlando, FL 32819-8647
Phone (689) 282-6774
Other practice location 23
203 Fort Wade Rd Unit 250
Ponte Vedra, FL 32081-5214
Phone (904) 902-4408
Other practice location 24
20950 N Tatum Blvd Ste 380
Phoenix, AZ 85050-4258
Phone (480) 626-7584
Other practice location 25
7455 W Washington Ave Ste 460
Las Vegas, NV 89128-4338
Phone (725) 235-7883
Other practice location 26
12150 Monument Dr Ste 375
Fairfax, VA 22033-5577
Phone (571) 534-3900
Other practice location 27
12150 Monument Dr Ste 815
Fairfax, VA 22033-4064
Phone (571) 534-3900
Other practice location 28
6354 Walker Ln Ste 450
Alexandria, VA 22310-3252
Phone (571) 534-3900
Other practice location 29
3 Sugar Creek Center Blvd Ste 600
Sugar Land, TX 77478-2213
Phone (346) 537-1292
Other practice location 30
3355 W Alabama St Ste 960
Houston, TX 77098-1874
Phone (346) 537-1292
Other practice location 31
118 Whittier Hwy Ste 5
Moultonborough, NH 03254-3618
Phone (801) 821-2333
Other practice location 32
6550 S Millrock Dr Ste 250
Holladay, UT 84121-2331
Phone (801) 821-2333
Other practice location 33
255 Primera Blvd Ste 264
Lake Mary, FL 32746-2148
Phone (689) 282-6774
Other practice location 34
3355 W Alabama St Ste 1100
Houston, TX 77098-1868
Phone (346) 537-1292
Other practice location 35
1505 Wigwam Pkwy Ste 211
Henderson, NV 89074-8195
Phone (725) 235-7883
Other practice location 36
10622 State Highway 151 Ste 209
San Antonio, TX 78251-4864
Phone (726) 207-5519
Other practice location 37
2695 Rocky Mountain Ave Ste 350
Loveland, CO 80538-9077
Phone (720) 712-0306
Other practice location 38
500 Discovery Pkwy Ste 250
Superior, CO 80027-8762
Phone (720) 302-1505
Other practice location 39
1760 E Pecos Rd Ste 247
Gilbert, AZ 85295-3214
Phone (480) 626-7584
Other practice location 40
1415 Legacy Dr Ste 220
Frisco, TX 75034-6025
Phone (817) 527-8621
Other practice location 41
9600 N Mopac Expy Ste 650
Austin, TX 78759-6507
Phone (512) 955-8474
Other practice location 42
9600 N Mopac Expy Ste 225
Austin, TX 78759-6507
Phone (512) 955-8474
Other practice location 43
300 Colonial Center Pkwy Ste 350
Roswell, GA 30076-4893
Phone (678) 861-1832
Other practice location 44
2046 W Riverview Auto Dr Ste 401
Mesa, AZ 85201-7597
Phone (480) 626-7584
Other practice location 45
2849 Paces Ferry Rd SE Ste 350
Atlanta, GA 30339-3769
Phone (678) 861-1832
Other practice location 46
3700 Crestwood Pkwy NW Ste 975
Duluth, GA 30096-7212
Phone (678) 861-1832
Other practice location 47
2370 Corporate Cir Ste 230
Henderson, NV 89074-7752
Phone (725) 235-7883
Other practice location 48
395 W State Highway 114 Ste 120
Southlake, TX 76092-3631
Phone (817) 527-8621
Other practice location 49
2132 N Robins Dr Ste 300
Layton, UT 84041-7077
Phone (801) 821-2781
Other practice location 50
6071 E Woodmen Rd Ste 200
Colorado Springs, CO 80923-2609
Phone (720) 712-0306
Other practice location 51
10535 Park Meadows Blvd
Lone Tree, CO 80124
Phone (720) 712-0306
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ, CO, NH, NV, TX, FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 6
Care Compare profile
Medicare Care Compare- Specialty
- Psychiatry
- Education
- Arizona College of Osteopathic Medicine Mid Western University, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
118 Whittier Hwy
Suite 5
Moultonborough, NH 03254-3618
Phone (801) 821-2781
1501 N Gilbert Rd
Suite 206
Gilbert, AZ 85234-2394
Phone (480) 626-7584
203 Fort Wade Rd
Unit 260
Ponte Vedra, FL 32081-5159
Phone (904) 902-4408
20950 N Tatum Blvd
Suite 380
Phoenix, AZ 85050-4258
Phone (480) 626-7584
255 S Routt St
Suite 250
Lakewood, CO 80228-2214
Phone (720) 712-0306
3300 N Triumph Blvd
Suite 500
Lehi, UT 84043-6475
Phone (801) 821-2781
36457 N Gantzel Rd
Suite 102
San Tan Valley, AZ 85140-7343
Phone (480) 626-7584
44084 Riverside Pkwy
Suite 300
Leesburg, VA 20176-5102
Phone (571) 534-3900
990 Hammond Dr
Suite 600
Sandy Springs, GA 30328-5510
Phone (678) 861-1832
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100970 | AK | MD | Psychiatry Physician |
| CDR.0000580 | CO | MD | Psychiatry Physician |
| OS19270 | FL | MD | Psychiatry Physician |
| 98820 | GA | MD | Psychiatry Physician |
| 11583541-1234 | UT | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| District Medical Group, Inc | Psychiatry | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Serenity Mental Health Centers
- Psychiatry Physician
- Lehi, UT
- NPI 1710492095
AZ, CO, FL, NH, NV, TX
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788480000000",
"number": "1629308424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "990 HAMMOND DR STE 600",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303285510",
"fax_number": "480-210-0230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "990 HAMMOND DR STE 600",
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"telephone_number": "678-861-1832",
"fax_number": "678-585-2259"
}
],
"practiceLocations": [
{
"address_1": "6071 E Woodmen Rd Ste 135",
"address_purpose": "LOCATION",
"city": "Colorado Springs",
"state": "CO",
"postal_code": "809232608",
"country_code": "US",
"telephone_number": "720-712-0306",
"fax_number": "719-920-4016",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "841 Prudential Dr Ste 1100",
"address_purpose": "LOCATION",
"city": "Jacksonville",
"state": "FL",
"postal_code": "322078352",
"country_code": "US",
"telephone_number": "904-902-4408",
"fax_number": "904-420-4745",
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{
"address_1": "500 Discovery Pkwy Ste 350",
"address_purpose": "LOCATION",
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"state": "CO",
"postal_code": "800278639",
"country_code": "US",
"telephone_number": "720-712-0306",
"fax_number": "720-302-1505",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "9399 Crown Crest Blvd Ste 401",
"address_purpose": "LOCATION",
"city": "Parker",
"state": "CO",
"postal_code": "801388540",
"country_code": "US",
"telephone_number": "720-712-0306",
"fax_number": "720-302-1505",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1860 N 95th Ln Ste 300",
"address_purpose": "LOCATION",
"city": "Phoenix",
"state": "AZ",
"postal_code": "850375074",
"country_code": "US",
"telephone_number": "480-626-7584",
"fax_number": "480-210-0230",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "9102 Southpark Center Loop Ste 120",
"address_purpose": "LOCATION",
"city": "Orlando",
"state": "FL",
"postal_code": "328198626",
"country_code": "US",
"telephone_number": "689-282-6774",
"fax_number": "689-206-0506",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "145 W 200 N Ste 600",
"address_purpose": "LOCATION",
"city": "Provo",
"state": "UT",
"postal_code": "846013016",
"country_code": "US",
"telephone_number": "801-821-2781",
"fax_number": "801-901-1194",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "18615 Tuscany Stone Ste 250",
"address_purpose": "LOCATION",
"city": "San Antonio",
"state": "TX",
"postal_code": "782583504",
"country_code": "US",
"telephone_number": "726-207-5519",
"fax_number": "726-245-0052",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "425 S Cherry St Fl 10",
"address_purpose": "LOCATION",
"city": "Denver",
"state": "CO",
"postal_code": "802461226",
"country_code": "US",
"telephone_number": "720-712-0306",
"fax_number": "720-302-1505",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "255 S Routt St Ste 250",
"address_purpose": "LOCATION",
"city": "Lakewood",
"state": "CO",
"postal_code": "802282214",
"country_code": "US",
"telephone_number": "720-712-0306",
"fax_number": "720-302-1505",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6500 West Fwy Ste 700",
"address_purpose": "LOCATION",
"city": "Fort Worth",
"state": "TX",
"postal_code": "761162180",
"country_code": "US",
"telephone_number": "817-527-8621",
"fax_number": "817-502-3632",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1501 N Gilbert Rd Ste 206",
"address_purpose": "LOCATION",
"city": "Gilbert",
"state": "AZ",
"postal_code": "852342394",
"country_code": "US",
"telephone_number": "480-626-7584",
"fax_number": "480-210-0230",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3300 N Triumph Blvd Ste 500",
"address_purpose": "LOCATION",
"city": "Lehi",
"state": "UT",
"postal_code": "840436475",
"country_code": "US",
"telephone_number": "801-821-2781",
"fax_number": "801-901-1194",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "255 Primera Blvd Ste 520",
"address_purpose": "LOCATION",
"city": "Lake Mary",
"state": "FL",
"postal_code": "327462158",
"country_code": "US",
"telephone_number": "689-282-6774",
"fax_number": "689-206-0506",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "44084 Riverside Pkwy Ste 300",
"address_purpose": "LOCATION",
"city": "Leesburg",
"state": "VA",
"postal_code": "201765102",
"country_code": "US",
"telephone_number": "571-534-3900",
"fax_number": "703-552-9318",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2221 Lakeside Blvd Ste 1225",
"address_purpose": "LOCATION",
"city": "Richardson",
"state": "TX",
"postal_code": "750824370",
"country_code": "US",
"telephone_number": "817-527-8621",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2695 Rocky Mountain Ave Ste 260",
"address_purpose": "LOCATION",
"city": "Loveland",
"state": "CO",
"postal_code": "805389075",
"country_code": "US",
"telephone_number": "720-712-0306",
"fax_number": "720-302-1505",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "7455 W Washington Ave Ste 420",
"address_purpose": "LOCATION",
"city": "Las Vegas",
"state": "NV",
"postal_code": "891284352",
"country_code": "US",
"telephone_number": "725-235-7883",
"fax_number": "725-201-1766",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3800 Gaylord Pkwy Ste 1100",
"address_purpose": "LOCATION",
"city": "Frisco",
"state": "TX",
"postal_code": "750349416",
"country_code": "US",
"telephone_number": "817-527-8621",
"fax_number": "817-502-3632",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4545 E Chandler Blvd Ste 308",
"address_purpose": "LOCATION",
"city": "Phoenix",
"state": "AZ",
"postal_code": "850487646",
"country_code": "US",
"telephone_number": "480-626-7584",
"fax_number": "480-210-0230",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2355 E Camelback Rd Ste 625",
"address_purpose": "LOCATION",
"city": "Phoenix",
"state": "AZ",
"postal_code": "850163458",
"country_code": "US",
"telephone_number": "480-626-7584",
"fax_number": "480-210-0230",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "9400 Southpark Center Loop Ste 450",
"address_purpose": "LOCATION",
"city": "Orlando",
"state": "FL",
"postal_code": "328198647",
"country_code": "US",
"telephone_number": "689-282-6774",
"fax_number": "689-206-0506",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "203 Fort Wade Rd Unit 250",
"address_purpose": "LOCATION",
"city": "Ponte Vedra",
"state": "FL",
"postal_code": "320815214",
"country_code": "US",
"telephone_number": "904-902-4408",
"fax_number": "904-420-4745",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "20950 N Tatum Blvd Ste 380",
"address_purpose": "LOCATION",
"city": "Phoenix",
"state": "AZ",
"postal_code": "850504258",
"country_code": "US",
"telephone_number": "480-626-7584",
"fax_number": "480-210-0230",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "7455 W Washington Ave Ste 460",
"address_purpose": "LOCATION",
"city": "Las Vegas",
"state": "NV",
"postal_code": "891284338",
"country_code": "US",
"telephone_number": "725-235-7883",
"fax_number": "725-201-1766",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "12150 Monument Dr Ste 375",
"address_purpose": "LOCATION",
"city": "Fairfax",
"state": "VA",
"postal_code": "220335577",
"country_code": "US",
"telephone_number": "571-534-3900",
"fax_number": "703-552-9318",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "12150 Monument Dr Ste 815",
"address_purpose": "LOCATION",
"city": "Fairfax",
"state": "VA",
"postal_code": "220334064",
"country_code": "US",
"telephone_number": "571-534-3900",
"fax_number": "703-552-9318",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6354 Walker Ln Ste 450",
"address_purpose": "LOCATION",
"city": "Alexandria",
"state": "VA",
"postal_code": "223103252",
"country_code": "US",
"telephone_number": "571-534-3900",
"fax_number": "703-552-9318",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3 Sugar Creek Center Blvd Ste 600",
"address_purpose": "LOCATION",
"city": "Sugar Land",
"state": "TX",
"postal_code": "774782213",
"country_code": "US",
"telephone_number": "346-537-1292",
"fax_number": "346-200-5131",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3355 W Alabama St Ste 960",
"address_purpose": "LOCATION",
"city": "Houston",
"state": "TX",
"postal_code": "770981874",
"country_code": "US",
"telephone_number": "346-537-1292",
"fax_number": "346-200-5131",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "118 Whittier Hwy Ste 5",
"address_purpose": "LOCATION",
"city": "Moultonborough",
"state": "NH",
"postal_code": "032543618",
"country_code": "US",
"telephone_number": "801-821-2333",
"fax_number": "801-901-1194",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6550 S Millrock Dr Ste 250",
"address_purpose": "LOCATION",
"city": "Holladay",
"state": "UT",
"postal_code": "841212331",
"country_code": "US",
"telephone_number": "801-821-2333",
"fax_number": "801-901-1194",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "255 Primera Blvd Ste 264",
"address_purpose": "LOCATION",
"city": "Lake Mary",
"state": "FL",
"postal_code": "327462148",
"country_code": "US",
"telephone_number": "689-282-6774",
"fax_number": "689-206-0506",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3355 W Alabama St Ste 1100",
"address_purpose": "LOCATION",
"city": "Houston",
"state": "TX",
"postal_code": "770981868",
"country_code": "US",
"telephone_number": "346-537-1292",
"fax_number": "346-200-5131",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1505 Wigwam Pkwy Ste 211",
"address_purpose": "LOCATION",
"city": "Henderson",
"state": "NV",
"postal_code": "890748195",
"country_code": "US",
"telephone_number": "725-235-7883",
"fax_number": "725-201-7451",
"country_name": "United States",
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"address_1": "10622 State Highway 151 Ste 209",
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"address_1": "2695 Rocky Mountain Ave Ste 350",
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"address_1": "500 Discovery Pkwy Ste 250",
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{
"address_1": "1760 E Pecos Rd Ste 247",
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{
"address_1": "1415 Legacy Dr Ste 220",
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"city": "Frisco",
"state": "TX",
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{
"address_1": "9600 N Mopac Expy Ste 650",
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{
"address_1": "9600 N Mopac Expy Ste 225",
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{
"address_1": "300 Colonial Center Pkwy Ste 350",
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"city": "Roswell",
"state": "GA",
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{
"address_1": "2046 W Riverview Auto Dr Ste 401",
"address_purpose": "LOCATION",
"city": "Mesa",
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{
"address_1": "2849 Paces Ferry Rd SE Ste 350",
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"city": "Atlanta",
"state": "GA",
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"telephone_number": "678-861-1832",
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{
"address_1": "3700 Crestwood Pkwy NW Ste 975",
"address_purpose": "LOCATION",
"city": "Duluth",
"state": "GA",
"postal_code": "300967212",
"country_code": "US",
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{
"address_1": "2370 Corporate Cir Ste 230",
"address_purpose": "LOCATION",
"city": "Henderson",
"state": "NV",
"postal_code": "890747752",
"country_code": "US",
"telephone_number": "725-235-7883",
"fax_number": "725-201-1766",
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{
"address_1": "395 W State Highway 114 Ste 120",
"address_purpose": "LOCATION",
"city": "Southlake",
"state": "TX",
"postal_code": "760923631",
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"telephone_number": "817-527-8621",
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{
"address_1": "2132 N Robins Dr Ste 300",
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"city": "Layton",
"state": "UT",
"postal_code": "840417077",
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"telephone_number": "801-821-2781",
"fax_number": "801-901-1194",
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{
"address_1": "6071 E Woodmen Rd Ste 200",
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"city": "Colorado Springs",
"state": "CO",
"postal_code": "809232609",
"country_code": "US",
"telephone_number": "720-712-0306",
"fax_number": "719-920-4016",
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{
"address_1": "10535 Park Meadows Blvd",
"address_purpose": "LOCATION",
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"state": "CO",
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"fax_number": "720-652-4702",
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],
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"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-12-30",
"last_updated": "2026-09-04",
"certification_date": "2026-09-04",
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}
Other providers in Sandy Springs, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.