Active NPI
David Wayne Proefrock, PHD
- Clinical Psychologist
- Martinez, GA
National Provider Identifier
1649537119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 759
- Practice address
- 4684 Oakley Pirkle Rd
Martinez, GA 30907-8853 - Phone
- (706) 863-4534
- NPI assigned
- Apr 20, 2012
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 759 | GA | Primary |
Addresses
Primary practice location
4684 Oakley Pirkle Rd
Martinez, GA 30907-8853
Mailing address
4684 Oakley Pirkle Rd
Martinez, GA 30907-8853
Phone (706) 863-4534
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 759 | GA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334880000000",
"number": "1649537119",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4684 OAKLEY PIRKLE RD",
"city": "MARTINEZ",
"state": "GA",
"postal_code": "309078853",
"telephone_number": "706-863-4534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4684 OAKLEY PIRKLE RD",
"city": "MARTINEZ",
"state": "GA",
"postal_code": "309078853",
"telephone_number": "706-863-4534"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROEFROCK",
"first_name": "DAVID",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-04-20",
"last_updated": "2012-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "759",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Martinez, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.