Active NPI
Christine Jo Jennings, PSY.D.
- Clinical Child & Adolescent Psychologist
- La Fayette, GA
National Provider Identifier
1285969089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 001559
- Practice address
- 406 N Main St
La Fayette, GA 30728-2424 - Phone
- (706) 638-2339
- Fax
- (706) 638-7400
- NPI assigned
- Oct 12, 2009
- Last updated
- Oct 12, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 001559 | 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 (706) 638-2339
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00484811C | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001559 | GA | MD | Clinical Child & Adolescent Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Georgia Psychological Services | 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.
-
- Psychologist
- La Fayette, GA
- NPI 1205919891
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255305600000",
"number": "1285969089",
"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": "706-638-2339",
"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": {
"last_name": "JENNINGS",
"first_name": "CHRISTINE",
"middle_name": "JO",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-12",
"last_updated": "2009-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "GA",
"license": "001559",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00484811C",
"state": "GA"
}
],
"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 Oct 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.