MEDICARE: COLUMBUS PSYCHOLOGICAL ASSOCIATES, LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073540589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS PSYCHOLOGICAL ASSOCIATES, LLP

Provider Business Mailing Address
First Line	:	2325 BROOKSTONE CENTRE PARKWAY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904
Country	:	US
Telephone Number	:	706-653-6841
Fax Number	:	706-653-7843

Provider Business Practice Location Address
First Line	:	2325 BROOKSTONE CENTRE PARKWAY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904
Country	:	US
Telephone Number	:	706-653-6841
Fax Number	:	706-653-7843

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JAIMELYN CONNELL
Credential	:
Telephone Number	:	706-653-6841

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	08/22/2020

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