Active NPI
Tiffany Anne Hodges, PSY.D
- Psychologist
- Kennesaw, GA
National Provider Identifier
1356582019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3258
- Practice address
- 1815 Old 41 Hwy NW
Suite 110
Kennesaw, GA 30152-4420 - Phone
- (770) 428-8686
- NPI assigned
- Mar 10, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 3258 | GA | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 3258 | GA |
Addresses
Primary practice location
1815 Old 41 Hwy NW
Suite 110
Kennesaw, GA 30152-4420
Mailing address
1815 Old 41 Hwy NW
Suite 110
Kennesaw, GA 30152-4420
Phone (770) 428-8686
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3258 | GA | MD | Electroneurodiagnostic Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236643200000",
"number": "1356582019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1815 OLD 41 HWY NW",
"address_2": "SUITE 110",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301524420",
"telephone_number": "770-428-8686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1815 OLD 41 HWY NW",
"address_2": "SUITE 110",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301524420",
"telephone_number": "770-428-8686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HODGES",
"first_name": "TIFFANY",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-10",
"last_updated": "2009-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "3258",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "GA",
"license": "3258",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 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.