NPIMap

Organization Active NPI

West Georgia Psychological Services

  • Clinical Psychologist
  • Douglasville, GA
National Provider Identifier
1962543579
Registry record updated Apr 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
002899 Issued in GA
Legal business name
WEST GEORGIA PSYCHOLOGICAL SERVICES
Practice address
6264 Hospital Way
Douglasville, GA 30134-1944
Phone
(678) 232-9078
Fax
(866) 489-2642
NPI assigned
Feb 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2012

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

Authorized official

Name
Dr. Tina Marie Caudill, PSY.D.NPI 1336120930
Title
Psychologist
Phone
(678) 232-9078

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
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 002899 GA Primary

Addresses

Primary practice location

6264 Hospital Way
Douglasville, GA 30134-1944

Mailing address

PO Box 1916
Douglasville, GA 30133-1916
Phone (678) 232-9078

Other identifiers 5

IdentifierTypeStateIssuer
112025855CMedicaidGA
10071390OtherGAAMERIGROUP
112025855EMedicaidGA
112025855DMedicaidGA
112025855FMedicaidGA

National Provider Directory

National Provider Directory

Locations

6264 Hospital Way
Douglasville, GA 30134
Phone (678) 232-9078

Practitioners & affiliated clinicians

Practitioners 3

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": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335225600000",
    "number": "1962543579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1916",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301331916",
            "telephone_number": "678-232-9078",
            "fax_number": "866-489-2642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6264 HOSPITAL WAY",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301341944",
            "telephone_number": "678-232-9078",
            "fax_number": "866-489-2642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST GEORGIA PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2012-04-24",
        "status": "A",
        "authorized_official_last_name": "CAUDILL",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "678-232-9078",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "002899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112025855C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10071390",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112025855E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112025855D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112025855F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; 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.