Insight Psychological Solutions LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

INSIGHT PSYCHOLOGICAL SOLUTIONS LLC

Practice address

12461 Veterans Memorial Hwy Ste 794
Douglasville, GA 30134-2025

Phone

(404) 854-4427

NPI assigned

Mar 6, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Samantha Renee Jordan, PSYDNPI 1366786527

Title

Owner

Phone

(404) 854-4427

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samantha R Jordan, PSYD

  • Psychologist
  • Marietta, GA
  • NPI 1366786527
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678060800000",
    "number": "1154021350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12461 VETERANS MEMORIAL HWY STE 794",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301342025",
            "telephone_number": "404-854-4427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12461 VETERANS MEMORIAL HWY STE 794",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301342025",
            "telephone_number": "404-854-4427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSIGHT PSYCHOLOGICAL SOLUTIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-06",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-854-4427",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.