1154532323 NPI number — W A HAYS CENTER FOR PSYCHOLOGICAL HEALTH, INC.

Table of content: JESSICA REIN CODY M.D. (NPI 1710372305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154532323 NPI number — W A HAYS CENTER FOR PSYCHOLOGICAL HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
W A HAYS CENTER FOR PSYCHOLOGICAL HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154532323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 KINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30606-3118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-546-0257
Provider Business Mailing Address Fax Number:
706-548-5609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 KINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-3118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-546-0257
Provider Business Practice Location Address Fax Number:
706-548-5609
Provider Enumeration Date:
05/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KNIGHT
Authorized Official First Name:
SYLVIA
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
706-546-0257

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  012220 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PSY000909 . This is a "GEORGIA SEC OF STATE LICENSURE BOARD FOR PSYCHOLOGY" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: H71701 . This is a "CORPORATION STATE LIC.#" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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