Active NPI
Philip Shaffer, PH.D.
- Counseling Psychologist
- Carrollton, GA
National Provider Identifier
1649588690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 6951
- Practice address
- 180 Martin Dr
Carrollton, GA 30117-2425 - Phone
- (404) 321-6111
- NPI assigned
- Sep 23, 2010
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 6951 | OH | Primary |
| Clinical Psychologist | 103TC0700X | 6951 | OH | |
| Group Psychotherapy Psychologist | 103TP2701X | 6951 | OH |
Addresses
Primary practice location
180 Martin Dr
Carrollton, GA 30117-2425
Mailing address
180 Martin Dr
Carrollton, GA 30117-2425
Phone (404) 321-6111
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427328000000",
"number": "1649588690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 MARTIN DR",
"city": "CARROLLTON",
"state": "GA",
"postal_code": "301172425",
"telephone_number": "404-321-6111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "180 MARTIN DR",
"city": "CARROLLTON",
"state": "GA",
"postal_code": "301172425",
"telephone_number": "404-321-6111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFFER",
"first_name": "PHILIP",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-23",
"last_updated": "2015-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "OH",
"license": "6951",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "6951",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "OH",
"license": "6951",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carrollton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.