Active NPI
Kenneth Charles Frontman, PH.D.
- Psychologist
- Roswell, GA
National Provider Identifier
1568525202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1835
- Practice address
- 1150 Upper Hembree Road
Roswell, GA 30076-1142 - Phone
- (678) 624-0930
- Fax
- (678) 624-0730
- NPI assigned
- Dec 17, 2006
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 001835 | GA | |
| Psychologist | 103T00000X | 1835 | GA | Primary |
Addresses
Primary practice location
1150 Upper Hembree Road
Roswell, GA 30076-1142
Mailing address
11285 Elkins Rd
Ste D3
Roswell, GA 30076-5835
Phone (770) 559-9752
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00672526B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1835 | GA | MD | Psychologist |
| 001835 | GA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Caron of Georgia LLC | Multi-Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651795200000",
"number": "1568525202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11285 ELKINS RD",
"address_2": "STE D3",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300765835",
"telephone_number": "770-559-9752",
"fax_number": "770-592-0510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1150 UPPER HEMBREE ROAD",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300761142",
"telephone_number": "678-624-0930",
"fax_number": "678-624-0730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRONTMAN",
"first_name": "KENNETH",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-17",
"last_updated": "2022-05-06",
"certification_date": "2022-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "001835",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "1835",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00672526B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roswell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.