Active NPI
Emily Brockett Jackson, PHD
- Clinical Psychologist
- Decatur, GA
National Provider Identifier
1003126962
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY003380
- Practice address
- 1670 Clairmont Road
Atlanta VA Medical Center
Decatur, GA 30033 - Phone
- (404) 429-0419
- NPI assigned
- Oct 13, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 | PSY003380 | GA | Primary |
Addresses
Primary practice location
1670 Clairmont Road
Atlanta VA Medical Center
Decatur, GA 30033
Mailing address
15 Cardinal CT
Stockbridge, GA 30281-1785
Phone (404) 429-0419
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 |
|---|---|---|---|
| PSY003380 | GA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772582400000",
"number": "1003126962",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 CARDINAL CT",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302811785",
"telephone_number": "404-429-0419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1670 CLAIRMONT ROAD",
"address_2": "ATLANTA VA MEDICAL CENTER",
"city": "DECATUR",
"state": "GA",
"postal_code": "30033",
"telephone_number": "404-429-0419"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "EMILY",
"middle_name": "BROCKETT",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-13",
"last_updated": "2026-03-04",
"certification_date": "2026-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY003380",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.