Georgia Psychological Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

GEORGIA PSYCHOLOGICAL SERVICES

Practice address

4139 Columbia Rd Ste a
Martinez, GA 30907-5401

Phone

(706) 210-3066

Fax

(706) 210-8703

NPI assigned

Jan 5, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David Wayne Proefrock, PHD

Title

Ceo

Phone

(706) 210-3066

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811044464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 211626",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309171626",
            "telephone_number": "706-210-3066",
            "fax_number": "706-210-8703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4139 COLUMBIA RD STE A",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309075401",
            "telephone_number": "706-210-3066",
            "fax_number": "706-210-8703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PROEFROCK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-210-3066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8840000796A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Martinez, GA
• Providers in Martinez, GA by specialty
• Community/Behavioral Health Agency 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.