Active NPI
Jun Yi Ginny Chan, PHD
- Clinical Psychologist
- Decatur, GA
National Provider Identifier
1598453656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY004130
- Practice address
- 3073 Panthersville Rd
Decatur, GA 30034-3828 - Phone
- (404) 243-2136
- NPI assigned
- Apr 26, 2023
- Sex
- Female
- 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 | PSY004130 | GA | Primary |
| Forensic Psychologist | 103TF0200X | PSY004130 | GA |
Addresses
Primary practice location
3073 Panthersville Rd
Decatur, GA 30034-3828
Mailing address
PMB 220 1579 Monroe Dr NE Suite F
Atlanta, GA 30324
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 |
|---|---|---|---|
| PSY004130 | GA | MD | Forensic Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682467200000",
"number": "1598453656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PMB 220 1579 MONROE DR NE SUITE F",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3073 PANTHERSVILLE RD",
"city": "DECATUR",
"state": "GA",
"postal_code": "300343828",
"telephone_number": "404-243-2136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "JUN YI GINNY",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-04-26",
"last_updated": "2023-04-26",
"certification_date": "2023-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY004130",
"primary": true
},
{
"code": "103TF0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Forensic",
"state": "GA",
"license": "PSY004130",
"primary": false
}
],
"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 Apr 26, 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.