Active NPI
Kathleen Elizabeth Grimes, PH.D.
- Clinical Psychologist
- Stockbridge, GA
National Provider Identifier
1457472185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY001812
- Practice address
- 110 Eagles Walk Ste 100
Stockbridge, GA 30281-7203 - Phone
- (770) 507-6044
- Fax
- (770) 507-5284
- NPI assigned
- Apr 2, 2007
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY001812 | GA | Primary |
Addresses
Primary practice location
110 Eagles Walk Ste 100
Stockbridge, GA 30281-7203
Mailing address
1697 Manhasset Dr
Dunwoody, GA 30338-3426
Phone (770) 394-2227
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY001812 | GA | MD | Clinical Psychologist |
| 1812 | GA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457472185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1697 MANHASSET DR",
"city": "DUNWOODY",
"state": "GA",
"postal_code": "303383426",
"telephone_number": "770-394-2227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 EAGLES WALK STE 100",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302817203",
"telephone_number": "770-507-6044",
"fax_number": "770-507-5284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMES",
"first_name": "KATHLEEN",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY001812",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.