NPIMap

Organization Active NPI

Living Fully Psychological Services, LLC

  • Clinical Psychologist
  • Decatur, GA
National Provider Identifier
1639439201
Registry record updated Mar 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY003405 Issued in GA
Legal business name
LIVING FULLY PSYCHOLOGICAL SERVICES, LLC
Practice address
111 N McDonough St
Decatur, GA 30030-3317
Phone
(678) 591-9117
Fax
(770) 458-8640
NPI assigned
May 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2013

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

Authorized official

Name
Dr. Pegah Moghaddam, PSY.D.
Title
Director
Phone
(678) 591-9117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PSY003405 GA Primary

Addresses

Primary practice location

111 N McDonough St
Decatur, GA 30030-3317

Mailing address

111 N McDonough St
Decatur, GA 30030-3317
Phone (678) 591-9117

Other names 1

  • Pegah Moghaddam, Psy.D. Other name

National Provider Directory

National Provider Directory

Locations

111 N McDonough St
Decatur, GA 30030
Phone (404) 446-6083

NPI Registry JSON

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

{
    "created_epoch": "1337212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362355200000",
    "number": "1639439201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N MCDONOUGH ST",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300303317",
            "telephone_number": "678-591-9117",
            "fax_number": "770-458-8640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N MCDONOUGH ST",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300303317",
            "telephone_number": "678-591-9117",
            "fax_number": "770-458-8640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING FULLY PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-17",
        "last_updated": "2013-03-04",
        "status": "A",
        "authorized_official_last_name": "MOGHADDAM",
        "authorized_official_first_name": "PEGAH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "678-591-9117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pegah Moghaddam, Psy.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2013; 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.