Active NPI
Julie R Chrysosferidis, PHD
- Clinical Psychologist
- Decatur, GA
National Provider Identifier
1417728593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 004746
- Practice address
- 235 E Ponce de Leon Ave Ste 200
Decatur, GA 30030-3412 - Phone
- (912) 655-5751
- NPI assigned
- Jan 9, 2024
- 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 Psychologist | 103TC0700X | 004746 | GA | Primary |
Addresses
Primary practice location
235 E Ponce de Leon Ave Ste 200
Decatur, GA 30030-3412
Mailing address
4301 Druid Hills Reserve Dr NE
Atlanta, GA 30329-2047
Phone (912) 655-5751
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004746 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704758400000",
"number": "1417728593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4301 DRUID HILLS RESERVE DR NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303292047",
"telephone_number": "912-655-5751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "235 E PONCE DE LEON AVE STE 200",
"city": "DECATUR",
"state": "GA",
"postal_code": "300303412",
"telephone_number": "912-655-5751"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHRYSOSFERIDIS",
"first_name": "JULIE",
"middle_name": "R",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-09",
"last_updated": "2024-01-09",
"certification_date": "2024-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "004746",
"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 Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.