Mary Gresham, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1204 Issued in GA

Practice address

2801 Buford Hwy NE Ste 260
Atlanta, GA 30329-2137

Phone

(404) 320-6510

Fax

(404) 321-0311

NPI assigned

Mar 28, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2014 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Paul M. Kimmell M.D. PC

  • Psychiatry Physician
  • Atlanta, GA
  • NPI 1568807790
  NPD (past)

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740309319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 BUFORD HWY NE STE 260",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292137",
            "telephone_number": "404-320-6510",
            "fax_number": "404-321-0311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 BUFORD HWY NE STE 260",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292137",
            "telephone_number": "404-320-6510",
            "fax_number": "404-321-0311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRESHAM",
        "first_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Louise Greissinger, DMD
• Robert Grell, M.D.
• Gresham Family Eyecare
• Angela Gresham, M.A.
• Jill Elizabeth Gresham, RBT
• Natalie Lucia Gresham
• Suzanne Orr Gresle, PH.D., CCC-SLP
• Anna-Marie Coons Gretchen, CPNP
• Alexander Craig McConnell Greven
• Sarah Kiran Grewal, DO, MPH

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

• 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.
• 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.