Provider Demographics
NPI:1174601348
Name:AFFILIATED PSYCHOLOGICAL & MEDICAL CONSULTANTS, LLC
Entity type:Organization
Organization Name:AFFILIATED PSYCHOLOGICAL & MEDICAL CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUANN
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-630-4963
Mailing Address - Street 1:200 W ACADEMY NW
Mailing Address - Street 2:STE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-8524
Mailing Address - Country:US
Mailing Address - Phone:770-535-1284
Mailing Address - Fax:770-536-3888
Practice Address - Street 1:200 W ACADEMY STREET NW
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-8524
Practice Address - Country:US
Practice Address - Phone:770-535-1284
Practice Address - Fax:770-536-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55001088AMedicaid
GAGRP225Medicare ID - Type UnspecifiedMEDICAIRE GROUP NUMBER