Active NPI
Theresa Welles, PH.D.
- Psychologist
- Duluth, GA
National Provider Identifier
1851719710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY003526
- Practice address
- 3650 Steve Reynolds Blvd.
Duluth, GA 30096 - Phone
- (770) 931-6200
- Fax
- (770) 931-6042
- NPI assigned
- Mar 28, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY003526 | GA | Primary |
Addresses
Primary practice location
3650 Steve Reynolds Blvd.
Duluth, GA 30096
Mailing address
3495 Piedmont Road, NE
Nine Piedmont Center
Atlanta, GA 30305
Phone (404) 364-7070
Other names 1
- Theresa Lopez
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY003526 | GA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395964800000",
"number": "1851719710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3495 PIEDMONT ROAD, NE",
"address_2": "NINE PIEDMONT CENTER",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30305",
"telephone_number": "404-364-7070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3650 STEVE REYNOLDS BLVD.",
"city": "DULUTH",
"state": "GA",
"postal_code": "30096",
"telephone_number": "770-931-6200",
"fax_number": "770-931-6042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLES",
"first_name": "THERESA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-28",
"last_updated": "2014-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "PSY003526",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "THERESA",
"last_name": "LOPEZ",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Duluth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.