Jason Fordyce, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN223272 Issued in GA

Practice address

307 Old Stone Rd
Villa Rica, GA 30180-1214

Phone

(770) 459-8799

NPI assigned

Jun 3, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BCEGCD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gwinnett Physician Group, LLC

  • Internal Medicine Physician
  • Lawrenceville, GA
  • NPI 1578574661
  Medicare reassignment NPD
• Mobolaji Shalom Oyebanjo, Inc

  • Psychiatry Physician
  • Villa Rica, GA
  • NPI 1922280684
  Medicare reassignment NPD
• Potters Hands Institute LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Villa Rica, GA
  • NPI 1386964690
  NPD (past)

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

{
    "created_epoch": "1622678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1346816865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 OLD STONE RD",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801214",
            "telephone_number": "770-459-8799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 OLD STONE RD",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801214",
            "telephone_number": "770-459-8799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORDYCE",
        "first_name": "JASON",
        "name_prefix": "Mr.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-03",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN223272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Fleischmann, DPT
• Donald Lowell Fletcher, D.C.
• Abbey Kate Folsom
• Ford Family Eye Care, P.C.
• Jennifer Yvonne Ford, NP
• April Jiles Fortenberry, PNP-PC
• Tadia Alexandria Foster, LMSW
• Foundation Community Services, LLC
• Oluseyi Fowowe
• Taiwo Olusegun Fowowe

• Psychiatric/Mental Health Nurse Practitioner in Villa Rica, GA
• Providers in Villa Rica, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; 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.