Active NPI
George Jacoby, M.A. SLPE
- Clinical Psychologist
- Memphis, TN
National Provider Identifier
1518107101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 310
- Practice address
- 3810 Winchester Rd
Memphis, TN 38118-6045 - Phone
- (901) 369-1420
- Fax
- (901) 369-1433
- NPI assigned
- Feb 23, 2009
- Last updated
- Feb 23, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 310 | TN | Primary |
Addresses
Primary practice location
3810 Winchester Rd
Memphis, TN 38118-6045
Mailing address
1987 James Rd
Memphis, TN 38127-8826
Phone (901) 353-9716
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
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 310 | TN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235347200000",
"number": "1518107101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1987 JAMES RD",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381278826",
"telephone_number": "901-353-9716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3810 WINCHESTER RD",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381186045",
"telephone_number": "901-369-1420",
"fax_number": "901-369-1433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBY",
"first_name": "GEORGE",
"name_prefix": "Mr.",
"credential": "M.A. SLPE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-02-23",
"last_updated": "2009-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.