Samantha R Jordan, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY003632 Issued in GA

Practice address

2520 Windy Hill Rd SE
Suite 203
Marietta, GA 30067-8664

Phone

(770) 953-6401

Fax

(770) 953-6015

NPI assigned

Nov 12, 2012

Last updated

Nov 12, 2012By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Insight Psychological Solutions LLC

  • Clinical Psychologist
  • Douglasville, GA
  • NPI 1154021350
  Medicare reassignment NPD Authorized official
• Atlanta Area Psychological Associates, P.C.

  • Psychologist
  • Marietta, GA
  • NPI 1720131253
  Medicare reassignment NPD

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

{
    "created_epoch": "1352678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352678400000",
    "number": "1366786527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 WINDY HILL RD SE",
            "address_2": "SUITE 203",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678664",
            "telephone_number": "770-953-6401",
            "fax_number": "770-953-6015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 WINDY HILL RD SE",
            "address_2": "SUITE 203",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678664",
            "telephone_number": "770-953-6401",
            "fax_number": "770-953-6015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "SAMANTHA",
        "middle_name": "R",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-12",
        "last_updated": "2012-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY003632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Jordan, OT
• Johanna R Jordan
• Madhavi Jordan, MD
• Mecca Imani Jordan
• Rachel Jordan
• Sheniqueka Jordan
• Wronda Jo Jordan, CNM
• Camille Jorek
• Jortay Diagnostic
• Jose Goncalves PC

• Psychologist in Marietta, GA
• Providers in Marietta, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.