NPIMap

Organization Active NPI

Psychology Clinic

  • Clinical Psychologist
  • Athens, GA
National Provider Identifier
1891979803
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
001667 Issued in GA
Legal business name
PSYCHOLOGY CLINIC
Practice address
139 Psychology BLDG.
The University of Georgia
Athens, GA 30602
Phone
(706) 542-1173
Fax
(706) 542-8048
NPI assigned
Dec 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

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

Authorized official

Name
Dr. Amos Zeichner, PH.D.
Title
Clinical Director
Phone
(706) 542-1173

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 001667 GA Primary

Addresses

Primary practice location

139 Psychology BLDG.
The University of Georgia
Athens, GA 30602

Mailing address

139 Psychology Building Baldwin Street
The University of Georgia
Athens, GA 30602-3061
Phone (706) 542-1173

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040602001084 GA Part B Supplier - Clinic/Group Practice 8729060967 Receives reassigned benefits from 21 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Athens, GA

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

139 Psychology
Bldg Baldwin St
Athens, GA 30602
Phone (706) 542-1173

139 Psychology
Athens, GA 30602
Phone (706) 542-1173

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660176000000",
    "number": "1891979803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 PSYCHOLOGY BUILDING BALDWIN STREET",
            "address_2": "THE UNIVERSITY OF GEORGIA",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306023061",
            "telephone_number": "706-542-1173",
            "fax_number": "706-542-8048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 PSYCHOLOGY BLDG.",
            "address_2": "THE UNIVERSITY OF GEORGIA",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "30602",
            "telephone_number": "706-542-1173",
            "fax_number": "706-542-8048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A",
        "authorized_official_last_name": "ZEICHNER",
        "authorized_official_first_name": "AMOS",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "706-542-1173",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "001667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; 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.