Annie Derthick, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY900357 Issued in GA

Practice address

4255 Wade Green Rd NW Ste 414
Kennesaw, GA 30144-1763

Phone

(678) 213-2194

NPI assigned

Dec 21, 2015

Last updated

Aug 18, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

85.02 of 100Reported as group

Quality

59.99

Promoting interoperability

99

Improvement activities

40

Cost

74.25

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/

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.

• Central Maine Medical Center

  • General Acute Care Hospital
  • Lewiston, ME
  • NPI 1689653487
  Medicare reassignment NPD
• Central Maine Medical Center

  dba CMMC Specialty Pharmacy

  • Community/Retail Pharmacy
  • Lewiston, ME
  • NPI 1033874458
  NPD
• Central Maine Medical Center

  dba CMMC Pharmacy

  • Community/Retail Pharmacy
  • Lewiston, ME
  • NPI 1861433765
  NPD (past)

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

{
    "created_epoch": "1450656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787011200000",
    "number": "1689039422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N SCOTTSDALE RD STE 2500",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4255 WADE GREEN RD NW STE 414",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301441763",
            "telephone_number": "678-213-2194"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 E 36th Ave",
            "address_purpose": "LOCATION",
            "city": "Anchorage",
            "state": "AK",
            "postal_code": "995084372",
            "country_code": "US",
            "telephone_number": "907-562-9229",
            "fax_number": "907-561-4806",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "76 High St",
            "address_purpose": "LOCATION",
            "city": "Lewiston",
            "state": "ME",
            "postal_code": "04240",
            "country_code": "US",
            "telephone_number": "207-795-2800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERTHICK",
        "first_name": "ANNIE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-21",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AK",
            "license": "107779",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY900357",
            "primary": true
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "ME",
            "license": "PS1563",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental One Associates (Kennesaw) LLC
• Dentfirst PC
• Dentistry at Kennesaw Point
• Donald Douglas Depew, DMD MS PC
• Deriche Agency Inc
• Shyamal Desai, PHARMD.
• Destination Trans LLC Dba Anywhere You Need to Go (Syncere Transportation)
• Douglas Jay Deuchar, D.M.D.
• Lydia L. Dever, DC
• Devereux Foundation

• Clinical Psychologist in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.

Verify at the official NPI Registry.