Active NPI
Harold Lamar Gardner Jr., PH.D
- Clinical Psychologist
- Martinez, GA
National Provider Identifier
1972652006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY000488
- Practice address
- 3990 Columbia Rd
Martinez, GA 30907-2220 - Phone
- (706) 860-1122
- Fax
- (706) 860-3839
- NPI assigned
- Jan 9, 2007
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY000488 | GA | Primary |
Addresses
Primary practice location
3990 Columbia Rd
Martinez, GA 30907-2220
Mailing address
PO Box 211008
Augusta, GA 30917-1008
Phone (706) 860-1122
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00083663A | 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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY000488 | GA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972652006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 211008",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309171008",
"telephone_number": "706-860-1122",
"fax_number": "706-860-3839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3990 COLUMBIA RD",
"city": "MARTINEZ",
"state": "GA",
"postal_code": "309072220",
"telephone_number": "706-860-1122",
"fax_number": "706-860-3839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "HAROLD",
"middle_name": "LAMAR",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PH.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY000488",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00083663A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Martinez, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.