Ann Marie Decker Frederick, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

90877 Issued in GA

Practice address

101 Quartz Dr Ste 103B
Villa Rica, GA 30180-3201

Phone

(770) 812-3530

Fax

(770) 812-3531

NPI assigned

Apr 29, 2016

Last updated

Dec 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Ann Marie Decker Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• TMC-Behavioral Health of West Georgia

  dba Behavioral Health of West Georgia

  • Geriatric Psychiatry Physician
  • Villa Rica, GA
  • NPI 1356795462
  Medicare reassignment NPD
• Skyland Hi

  • Psychiatry Physician
  • Atlanta, GA
  • NPI 1518851237
  NPD
• Thrive Wellness Clinic, LLC

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1033413018
  NPD (past)
• Helen Ross McNabb Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Knoxville, TN
  • NPI 1558799361
  NPD (past)

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

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1245685064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GREENWAY BLVD STE C",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174358",
            "telephone_number": "770-812-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 QUARTZ DR STE 103B",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301803201",
            "telephone_number": "770-812-3530",
            "fax_number": "770-812-3531"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2830 Dresden Dr",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303413920",
            "country_code": "US",
            "telephone_number": "404-315-8333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "ANN",
        "middle_name": "MARIE DECKER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-29",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "90877",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "63157",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TN",
            "license": "63157",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "GA",
            "license": "90877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANN",
            "last_name": "DECKER",
            "middle_name": "MARIE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Child & Adolescent Psychiatry Physician in Villa Rica, GA
• Providers in Villa Rica, GA by specialty
• Child & Adolescent Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.