Active NPI
Robert Koontz, PH.D
- Clinical Social Worker
- Atlanta, GA
National Provider Identifier
1700948726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1129
- Practice address
- 1788 Century Blvd NE Ste B
Atlanta, GA 30345-3321 - Phone
- (404) 315-9987
- NPI assigned
- Dec 15, 2006
- 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 Social Worker | 1041C0700X | 1129 | GA | Primary |
Addresses
Primary practice location
1788 Century Blvd NE Ste B
Atlanta, GA 30345-3321
Mailing address
1788 Century Blvd NE Ste B
Atlanta, GA 30345-3321
Phone (404) 315-9987
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1129 | GA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700948726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1788 CENTURY BLVD NE STE B",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303453321",
"telephone_number": "404-315-9987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1788 CENTURY BLVD NE STE B",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303453321",
"telephone_number": "404-315-9987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOONTZ",
"first_name": "ROBERT",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "1129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.