Supportive Care of Georgia LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

SUPPORTIVE CARE OF GEORGIA LLC

Practice address

300 Colonial Center Pkwy Ste 100N
Roswell, GA 30076-4892

Phone

(718) 298-4375

NPI assigned

Jun 8, 2021

Organization subpart

No

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

Authorized official

Name

Raphael Lichtschein

Title

President

Phone

(718) 298-4375

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 3

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

• Contessa Direan Metcalfe, M.D.

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1639133135
  Medicare reassignment
• Sebrina Russell

  • Social Worker
  • Jonesboro, GA
  • NPI 1285266734
  Medicare reassignment
• Robert Clifton Glenn, MD

  • Psychiatry Physician
  • Redlands, CA
  • NPI 1902033210

  GA

  Medicare reassignment

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

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623110400000",
    "number": "1891362877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 RANDOLPH RD",
            "city": "HOWELL",
            "state": "NJ",
            "postal_code": "077318611",
            "telephone_number": "718-298-4375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COLONIAL CENTER PKWY STE 100N",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764892",
            "telephone_number": "718-298-4375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE CARE OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-08",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A",
        "authorized_official_last_name": "LICHTSCHEIN",
        "authorized_official_first_name": "RAPHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-298-4375"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Saveen Sundrani, LCSW
• Tagore Sunkara, MD
• Sunray ABA Ga LLC
• Sunshine Smiles Dentistry
• Superior Quality Group, Inc
• Surgical Physicians of Atlanta
• Neima Nuru Surur, MD
• Sydney Mara Suss, DNP CRNA
• Jill Denise Sutkus, PT
• Nicholas B Swanner, MPT, GCS

• Clinical Psychologist in Roswell, GA
• Providers in Roswell, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; 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.