NPIMap

Organization Active NPI

Creative Life Center, LLC

  • Geriatric Psychiatry Physician
  • Grayson, GA
National Provider Identifier
1780227140
Registry record updated May 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X
Legal business name
CREATIVE LIFE CENTER, LLC
Practice address
1637 Athens Hwy Ste B
Grayson, GA 30017-1768
Phone
(678) 344-8269
Fax
(888) 627-6444
NPI assigned
Oct 17, 2019
Last updated
May 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2021

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

Authorized official

Name
Muhammad S Ahmed, MDNPI 1043302037
Title
Ceo
Phone
(678) 344-8268

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Day Training/Habilitation Specialist 373H00000X NU
Psychiatry Physician 2084P0800X NU
Geriatric Psychiatry Physician 2084P0805X NU Primary

Addresses

Primary practice location

1637 Athens Hwy Ste B
Grayson, GA 30017-1768

Mailing address

1637 Athens Hwy
Grayson, GA 30017-1768
Phone (678) 344-8268

National Provider Directory

National Provider Directory

Locations

1637 Athens Hwy
Grayson, GA 30017
Phone (678) 344-8268

500 Plantation Park Dr
Loganville, GA 30052
Phone (678) 344-8268

2795 Main St W
Ste 21A
Snellville, GA 30078

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1571270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621296000000",
    "number": "1780227140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1637 ATHENS HWY",
            "city": "GRAYSON",
            "state": "GA",
            "postal_code": "300171768",
            "telephone_number": "678-344-8268",
            "fax_number": "888-627-6444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1637 ATHENS HWY STE B",
            "city": "GRAYSON",
            "state": "GA",
            "postal_code": "300171768",
            "telephone_number": "678-344-8269",
            "fax_number": "888-627-6444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE LIFE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-17",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "MUHAMMAD",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-344-8268",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grayson, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; 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.