Active NPI
Nicholas Charles Demetry, MD
- Psychiatry Physician
- Atlanta, GA
National Provider Identifier
1891969820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 030047
- Practice address
- 1870 The Exchange Ste 100
Atlanta, GA 30339 - Phone
- (770) 435-0180
- Fax
- (770) 951-7006
- NPI assigned
- Apr 22, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 030047 | GA | Primary |
Addresses
Primary practice location
1870 The Exchange Ste 100
Atlanta, GA 30339
Mailing address
1870 The Exchange Ste 100
Atlanta, GA 30339
Phone (770) 435-0180
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 17, 2015 through Feb 17, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 030047 | GA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208822400000",
"number": "1891969820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1870 THE EXCHANGE STE 100",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30339",
"telephone_number": "770-435-0180",
"fax_number": "770-951-7006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1870 THE EXCHANGE STE 100",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30339",
"telephone_number": "770-435-0180",
"fax_number": "770-951-7006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMETRY",
"first_name": "NICHOLAS",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-22",
"last_updated": "2008-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "030047",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.