Active NPI
Sherry L Blake, PHD
- Clinical Psychologist
- Atlanta, GA
National Provider Identifier
1124244934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY001267
- Practice address
- 1897 Godby Rd
Atlanta, GA 30349-5235 - Phone
- (770) 996-7622
- NPI assigned
- Apr 18, 2007
- 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 | PSY001267 | GA | Primary |
Addresses
Primary practice location
1897 Godby Rd
Atlanta, GA 30349-5235
Mailing address
1897 Godby Rd
Atlanta, GA 30349-5235
Phone (770) 996-7622
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000431395A | Medicaid | GA |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY001267 | GA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214870400000",
"number": "1124244934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1897 GODBY RD",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303495235",
"telephone_number": "770-996-7622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1897 GODBY RD",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303495235",
"telephone_number": "770-996-7622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKE",
"first_name": "SHERRY",
"middle_name": "L",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-18",
"last_updated": "2008-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY001267",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000431395A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.