NPIMap

Organization Active NPI

Promedica, Inc.

  • Mental Health Counselor
  • Loganville, GA
National Provider Identifier
1922036508
Registry record updated Apr 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
029689 Issued in GA
Legal business name
PROMEDICA, INC.
Practice address
2430 Tucker Dr
BLDG a
Loganville, GA 30052-4390
Phone
(770) 554-8812
Fax
(770) 554-9810
NPI assigned
Jun 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2008

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

Authorized official

Name
Ms. Kimberly H. Littrell, MS, APRN, BCNPI 1376600288
Title
President & Ceo
Phone
(770) 554-8812

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X 029689 GA Primary

Addresses

Primary practice location

2430 Tucker Dr
BLDG a
Loganville, GA 30052-4390

Mailing address

2430 Tucker Dr
BLDG a
Loganville, GA 30052-4390
Phone (770) 554-8812

Other identifiers 1

IdentifierTypeStateIssuer
00345408AMedicaidGA

Other names 1

  • PROMEDICA PSYCHIATRY GROUP Doing business as

National Provider Directory

National Provider Directory

Locations

4460 Atlanta Hwy
Ste B
Loganville, GA 30052
Phone (770) 519-0002

Practitioners & affiliated clinicians

Practitioners 4

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": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209340800000",
    "number": "1922036508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2430 TUCKER DR",
            "address_2": "BLDG A",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524390",
            "telephone_number": "770-554-8812",
            "fax_number": "770-554-9810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2430 TUCKER DR",
            "address_2": "BLDG A",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524390",
            "telephone_number": "770-554-8812",
            "fax_number": "770-554-9810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2008-04-28",
        "status": "A",
        "authorized_official_last_name": "LITTRELL",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "770-554-8812",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS, APRN, BC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "029689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00345408A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROMEDICA PSYCHIATRY GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loganville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; 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.