Active NPI
Adam Jackson Raulerson, LMFT
- Marriage & Family Therapist
- Gainesville, GA
National Provider Identifier
1962645515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 1001
- Practice address
- 915 Interstate Ridge Dr
Suite C and G
Gainesville, GA 30501-7076 - Phone
- (678) 207-1800
- NPI assigned
- Apr 13, 2009
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 1001 | GA | Primary |
Addresses
Primary practice location
915 Interstate Ridge Dr
Suite C and G
Gainesville, GA 30501-7076
Mailing address
4331 Thurmon Tanner Rd
Flowery Branch, GA 30542-2829
Phone (678) 513-5700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114988268 | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001 | GA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trifecta Health, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Dacula, GA
- NPI 1538706916
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239580800000",
"number": "1962645515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4331 THURMON TANNER RD",
"city": "FLOWERY BRANCH",
"state": "GA",
"postal_code": "305422829",
"telephone_number": "678-513-5700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "915 INTERSTATE RIDGE DR",
"address_2": "SUITE C AND G",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305017076",
"telephone_number": "678-207-1800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAULERSON",
"first_name": "ADAM",
"middle_name": "JACKSON",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-13",
"last_updated": "2009-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "GA",
"license": "1001",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1114988268",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.