Active NPI
Courtney Brooke Chambless, PH.D.
- Psychologist
- Decatur, GA
National Provider Identifier
1356604334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY003573
- Practice address
- 308 Clairemont Ave
Decatur, GA 30030-2506 - Phone
- (404) 542-7792
- NPI assigned
- Jun 24, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY003573 | GA | Primary |
Addresses
Primary practice location
308 Clairemont Ave
Decatur, GA 30030-2506
Mailing address
980 Hill St SE
Atlanta, GA 30315-1914
Phone (404) 542-7792
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250403003697 | CA | Practitioner - Clinical Psychologist | 5193249860 | Practice locations: Chico, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
5 Governors LN
Suite 150
Chico, CA 95926-5527
Phone (404) 542-7791
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY003573 | GA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361318400000",
"number": "1356604334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "980 HILL ST SE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303151914",
"telephone_number": "404-542-7792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 CLAIREMONT AVE",
"city": "DECATUR",
"state": "GA",
"postal_code": "300302506",
"telephone_number": "404-542-7792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAMBLESS",
"first_name": "COURTNEY",
"middle_name": "BROOKE",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-24",
"last_updated": "2013-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "PSY003573",
"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 Feb 20, 2013; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.