Active NPI
Will McKinnley Prothro
- Health Psychologist
- Columbus, GA
National Provider Identifier
1720643448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Psychologist
- License
- 58-2108870
- Practice address
- 1215 2ND Ave
Columbus, GA 31901-5244 - Phone
- (706) 324-4061
- NPI assigned
- May 8, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Health Psychologist | 103TH0004X | 58-2108870 | GA | Primary |
Addresses
Primary practice location
1215 2ND Ave
Columbus, GA 31901-5244
Mailing address
1215 2ND Ave
Columbus, GA 31901-5244
Phone (706) 324-4061
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 58-2108870 | Medicaid | GA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58-2108870 | GA | MD | Health Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557964800000",
"number": "1720643448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1215 2ND AVE",
"city": "COLUMBUS",
"state": "GA",
"postal_code": "319015244",
"telephone_number": "706-324-4061",
"fax_number": "706-317-9895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1215 2ND AVE",
"city": "COLUMBUS",
"state": "GA",
"postal_code": "319015244",
"telephone_number": "706-324-4061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROTHRO",
"first_name": "WILL",
"middle_name": "MCKINNLEY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-05-08",
"last_updated": "2019-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": "GA",
"license": "58-2108870",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "58-2108870",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.