Active NPI
Jesse Fredeen, MD
- Psychiatry Physician
- Decatur, GA
National Provider Identifier
1104289420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 82526
- Practice address
- 1670 Clairmont Rd
Decatur, GA 30033-4004 - Phone
- (404) 621-6111
- NPI assigned
- Apr 4, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | 82526 | GA | Primary |
Addresses
Primary practice location
1670 Clairmont Rd
Decatur, GA 30033-4004
Mailing address
1670 Clairmont Rd
Decatur, GA 30033-4004
Phone (404) 321-6111
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 82526 | GA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650240000000",
"number": "1104289420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1670 CLAIRMONT RD",
"city": "DECATUR",
"state": "GA",
"postal_code": "300334004",
"telephone_number": "404-321-6111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1670 CLAIRMONT RD",
"city": "DECATUR",
"state": "GA",
"postal_code": "300334004",
"telephone_number": "404-621-6111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDEEN",
"first_name": "JESSE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-04-04",
"last_updated": "2022-04-18",
"certification_date": "2022-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "82526",
"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 Apr 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.