Keith James Fallon, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY002856 Issued in GA

Practice address

1100 Green St SW
Conyers, GA 30012-5220

Phone

(404) 502-5824

NPI assigned

Jan 16, 2007

Last updated

Jan 21, 2015By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Keith Fallon, Psy.D., P.C.

  • Psychologist
  • Conyers, GA
  • NPI 1801947569
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421798400000",
    "number": "1770635401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1790",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300127964",
            "telephone_number": "404-502-5824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 GREEN ST SW",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300125220",
            "telephone_number": "404-502-5824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALLON",
        "first_name": "KEITH",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2015-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY002856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375822929A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375822929B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fairview Community Personal Care Home, Inc.
• Sylvia Faison
• Faith Fulfillment Centers
• Babajide O. Falana, M.D.
• Ekundayo Adedapo Falase, MD
• Famcare Connect of Georgia LLC (FAMCare CONNECT)
• Famcare Connect of South Carolina LLC
• Family & Occupational Medicine of Conyers
• Family 360 Incorporated
• Family Home Medical Equipment, LLC (Total Respiratory)

• Psychologist in Conyers, GA
• Providers in Conyers, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.