Individual provider Active NPI

William Frank Thorneloe, MD

  • Psychiatry Physician
  • Smyrna, GA
National Provider Identifier
1932207123
Registry record updated Sep 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
23119 Issued in GA
Practice address
4015 S Cobb Dr SE Ste 270
Smyrna, GA 30080-6375
Phone
(770) 434-0677
Fax
(770) 434-3911
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 19, 2011

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Forensic Psychiatry Physician 2084F0202X 23119 GA
Psychiatry Physician 2084P0800X 23119 GA Primary
Geriatric Psychiatry Physician 2084P0805X 023119 GA
Forensic Psychiatry Physician 2084F0202X 8447 AL
Psychiatry Physician 2084P0800X 8447 AL
Geriatric Psychiatry Physician 2084P0805X 8447 AL

Addresses

Primary practice location

4015 S Cobb Dr SE Ste 270
Smyrna, GA 30080-6375

Mailing address

4015 S Cobb Dr SE Ste 270
Smyrna, GA 30080-6375
Phone (770) 434-0677

Other identifiers 1

IdentifierTypeStateIssuer
000246716BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040702000401 GA Practitioner - Psychiatry 4587641923 Practice locations: Smyrna, GA

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Virginia Commonwealth University, School of Medicine, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

4015 S Cobb Dr SE
Suite 270
Smyrna, GA 30080-6375
Phone (770) 434-0677

4015 S Cobb Sedr
Suite 270
Smyrna, GA 30080-6375

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
23119GAMDForensic Psychiatry Physician
8447ALMDGeriatric Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pathways Center for Behavioral and Developmental Growth Past Accepting new patients
Pathways Center for Behavioral & Developmental Growth PastSince Nov 24, 2019 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316390400000",
    "number": "1932207123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4015 S COBB DR SE STE 270",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300806375",
            "telephone_number": "770-434-0677",
            "fax_number": "770-434-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4015 S COBB DR SE STE 270",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300806375",
            "telephone_number": "770-434-0677",
            "fax_number": "770-434-3911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THORNELOE",
        "first_name": "WILLIAM",
        "middle_name": "FRANK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084F0202X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "GA",
            "license": "23119",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "23119",
            "primary": true
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "GA",
            "license": "023119",
            "primary": false
        },
        {
            "code": "2084F0202X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "AL",
            "license": "8447",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AL",
            "license": "8447",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "AL",
            "license": "8447",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000246716B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smyrna, GA

Sources for this page

Verify at the official NPI Registry.