NPIMap

Organization Active NPI

Northwest Georgia Psychological Services

  • Psychologist
  • La Fayette, GA
National Provider Identifier
1205919891
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1559 Issued in GA
Legal business name
NORTHWEST GEORGIA PSYCHOLOGICAL SERVICES
Practice address
406 N Main St
La Fayette, GA 30728-2424
Phone
(706) 638-2339
Fax
(706) 638-7400
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Christine Jo Jennings, PSY.D.NPI 1285969089
Title
Owner of P.C.
Phone
(706) 638-2339

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 1559 GA Primary

Addresses

Primary practice location

406 N Main St
La Fayette, GA 30728-2424

Mailing address

PO Box 1085
La Fayette, GA 30728-1085
Phone (707) 638-2339

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205919891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1085",
            "city": "LA FAYETTE",
            "state": "GA",
            "postal_code": "307281085",
            "telephone_number": "707-638-2339",
            "fax_number": "706-638-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 N MAIN ST",
            "city": "LA FAYETTE",
            "state": "GA",
            "postal_code": "307282424",
            "telephone_number": "706-638-2339",
            "fax_number": "706-638-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST GEORGIA PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JENNINGS",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "OWNER OF P.C.",
        "authorized_official_telephone_number": "706-638-2339",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "GA",
            "license": "1559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Fayette, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.