Active NPI
Felicia Lynette Jackson, PHD
- Psychologist
- Decatur, GA
National Provider Identifier
1225521313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 004434
- Practice address
- 1201 Clairmont Rd Ste 305a
Decatur, GA 30030-1258 - Phone
- (404) 692-7005
- NPI assigned
- Jun 13, 2018
- Last updated
- Apr 30, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 024378 | NY | |
| Psychologist | 103T00000X | 004434 | GA | Primary |
Addresses
Primary practice location
1201 Clairmont Rd Ste 305a
Decatur, GA 30030-1258
Mailing address
1201 Clairmont Rd Ste 305a
Decatur, GA 30030-1258
Phone (404) 692-7005
Other practice location 1
200 White Spruce Blvd Ste 220
Rochester, NY 14623-1605
Phone (585) 201-8017
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 |
|---|---|---|---|
| 024378 | NY | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesee Valley Psychology, PLLC | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Adult Mental Health Clinic/Center
- Rochester, NY
- NPI 1679114169
Psychologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651276800000",
"number": "1225521313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 CLAIRMONT RD STE 305A",
"city": "DECATUR",
"state": "GA",
"postal_code": "300301258",
"telephone_number": "404-692-7005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 CLAIRMONT RD STE 305A",
"city": "DECATUR",
"state": "GA",
"postal_code": "300301258",
"telephone_number": "404-692-7005"
}
],
"practiceLocations": [
{
"address_1": "200 White Spruce Blvd Ste 220",
"address_purpose": "LOCATION",
"city": "Rochester",
"state": "NY",
"postal_code": "146231605",
"country_code": "US",
"telephone_number": "585-201-8017",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "FELICIA",
"middle_name": "LYNETTE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-13",
"last_updated": "2022-04-30",
"certification_date": "2021-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "024378",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "004434",
"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 30, 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.