Active NPI
Stephanie Davis, PSYD
- Clinical Psychologist
- Decatur, GA
National Provider Identifier
1568169308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY004132
- Practice address
- 160 Clairemont Ave
Decatur, GA 30030-2500 - Phone
- (919) 436-3751
- NPI assigned
- Feb 13, 2023
- 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 | PSY004132 | GA | Primary |
Addresses
Primary practice location
160 Clairemont Ave
Decatur, GA 30030-2500
Mailing address
11555 Medlock Bridge Rd Ste 100
Johns Creek, GA 30097-3200
Phone (919) 436-3751
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY004132 | GA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683849600000",
"number": "1568169308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11555 MEDLOCK BRIDGE RD STE 100",
"city": "JOHNS CREEK",
"state": "GA",
"postal_code": "300973200",
"telephone_number": "919-436-3751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 CLAIREMONT AVE",
"city": "DECATUR",
"state": "GA",
"postal_code": "300302500",
"telephone_number": "919-436-3751"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "STEPHANIE",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-13",
"last_updated": "2023-05-12",
"certification_date": "2023-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY004132",
"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 May 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.