Active NPI
Jennifer Faye Kelly, PH.D.
- Clinical Psychologist
- Atlanta, GA
National Provider Identifier
1508922105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1523
- Practice address
- 3280 Howell Mill Rd NW
Suite 100
Atlanta, GA 30327-4111 - Phone
- (404) 351-6789
- Fax
- (404) 351-2932
- NPI assigned
- Dec 28, 2006
- 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 | 1523 | GA | Primary |
Addresses
Primary practice location
3280 Howell Mill Rd NW
Suite 100
Atlanta, GA 30327-4111
Mailing address
3280 Howell Mill Rd NW
Suite 100
Atlanta, GA 30327-4111
Phone (404) 351-6789
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00471732B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- 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 |
|---|---|---|---|---|
| I20100518000168 | GA | Practitioner - Clinical Psychologist | 0749318426 | Practice locations: Atlanta, GA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2325 Log Cabin Dr SE
Suite 105
Atlanta, GA 30339-6742
Phone (770) 319-5677
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1523 | GA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508922105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3280 HOWELL MILL RD NW",
"address_2": "SUITE 100",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303274111",
"telephone_number": "404-351-6789",
"fax_number": "404-351-2932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3280 HOWELL MILL RD NW",
"address_2": "SUITE 100",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303274111",
"telephone_number": "404-351-6789",
"fax_number": "404-351-2932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JENNIFER",
"middle_name": "FAYE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "1523",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00471732B",
"state": "GA"
}
],
"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 Jul 8, 2007; 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.