Juntira Laothavorn, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

076279 Issued in GA

Practice address

1745 Phoenix Blvd Ste 240
Atlanta, GA 30349-5534

Phone

(404) 507-7100

NPI assigned

Jun 25, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2017 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Amen Clinics, Inc Atlanta

  • Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
  • Atlanta, GA
  • NPI 1205342789

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1700140712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 N AVONDALE RD # 181",
            "city": "AVONDALE ESTATES",
            "state": "GA",
            "postal_code": "300021323",
            "telephone_number": "404-579-4544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1745 PHOENIX BLVD STE 240",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303495534",
            "telephone_number": "404-507-7100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "221 NE Glen Oak Ave",
            "address_2": "7West, Department of Psychiatry and Behavioral Medicine",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616360001",
            "country_code": "US",
            "telephone_number": "309-495-1640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAOTHAVORN",
        "first_name": "JUNTIRA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-25",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "125061354",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "076279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly Lantinberg
• Patricia M Lantis, MD
• Sandra-Lily Lantum
• Christopher Robert Lanyon
• Julia Lanza, GC
• Lapapoe LLC
• Marissa Benn Lapedis, M.D.
• Loren Filson Lapidus
• Lauren L Lapihuska, PA-C
• Richard Stephan Laplante, M.D.

• Psychiatry Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.