Rick Petronella

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

C0079 Issued in GA

Practice address

1010 Huntcliff Ste 1210
Sandy Springs, GA 30350-1809

Phone

(678) 395-7922

Fax

(678) 954-6589

NPI assigned

Jul 23, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1770136236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 HUNTCLIFF STE 1210",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303501809",
            "telephone_number": "678-395-7922",
            "fax_number": "678-954-6589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 HUNTCLIFF STE 1210",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303501809",
            "telephone_number": "678-395-7922",
            "fax_number": "678-954-6589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRONELLA",
        "first_name": "RICK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-23",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "C0079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "SandySprings",
            "affiliation": "N",
            "address_1": "1010 Huntcliff Ste 1210",
            "city": "Sandy Springs",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303501809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amelia Persaud, OTR/L, IBCLC
• Mark Persaud, DDS
• Personalized Healthcare, LLC
• Merlande Leonna Petithomme, CERTIFIED HAIR LOSS
• Bethany Rose Ann Petronella, LPC
• Hongduyen Pham, RBT
• David Alexander Phaup
• Janise Phillips
• Matthew Phillips, PHARM.D
• Physical Medicine of Sandy Springs

• Addiction (Substance Use Disorder) Counselor in Sandy Springs, GA
• Providers in Sandy Springs, GA by specialty
• Addiction (Substance Use Disorder) Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.

Verify at the official NPI Registry.