Active NPI
Ronald Herndon, PH.D.
- Psychologist
- Atlanta, GA
National Provider Identifier
1487059259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY003635
- Practice address
- 2289 Cloverdale Dr SE
Atlanta, GA 30316-2721 - Phone
- (404) 388-1436
- NPI assigned
- Oct 23, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 | PSY003635 | GA | Primary |
| Forensic Psychologist | 103TF0200X | PSY003635 | GA |
Addresses
Primary practice location
2289 Cloverdale Dr SE
Atlanta, GA 30316-2721
Mailing address
2289 Cloverdale Dr SE
Atlanta, GA 30316-2721
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 |
|---|---|---|---|
| PSY003635 | GA | MD | Forensic Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414022400000",
"number": "1487059259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2289 CLOVERDALE DR SE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303162721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2289 CLOVERDALE DR SE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303162721",
"telephone_number": "404-388-1436"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERNDON",
"first_name": "RONALD",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-23",
"last_updated": "2014-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "PSY003635",
"primary": true
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "GA",
"license": "PSY003635",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.