Keith Fallon, Psy.D., P.C.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY002856 Issued in GA

Legal business name

KEITH FALLON, PSY.D., P.C.

Practice address

1100 Green St SW
Conyers, GA 30012-5220

Phone

(404) 502-5824

NPI assigned

Jan 16, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Keith James Fallon, PSY.D.NPI 1770635401

Title

Ceo

Phone

(404) 502-5824

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Keith James Fallon, PSY.D.

  • Psychologist
  • Conyers, GA
  • NPI 1770635401
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801947569",
    "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": {
        "organization_name": "KEITH FALLON, PSY.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FALLON",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-502-5824",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY002856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shiraz Habib Kassam, M.D.
• Saman Kazemi, RPH
• Kbsolutions and Behavioral Support Services
• Kbsolutions and Behavioral Support Services
• Rotonda Keaton Williams, P.A.
• Calyn Kelly, FNP-C
• Tairra Kemp, LCSW
• Keion Kerr
• Wayne E Kerr, DDS
• Jennifer Angela Key, MS, NCC, LAPC

• 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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.