John B. Jolly, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

33-531 Issued in MS

Practice address

740 Avignon Dr Ste B
Ridgeland, MS 39157-5160

Phone

(601) 355-8378

Fax

(601) 354-5535

NPI assigned

Mar 19, 2007

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 9, 2017.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510185600000",
    "number": "1629192083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 AVIGNON DR STE B",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391575160",
            "telephone_number": "601-355-8378",
            "fax_number": "601-354-5535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 AVIGNON DR STE B",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391575160",
            "telephone_number": "601-355-8378",
            "fax_number": "601-354-5535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLLY",
        "first_name": "JOHN",
        "middle_name": "B.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2017-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MS",
            "license": "33-531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00114506",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Traci Lynn Johnson, COTA
• Vertisha Johnson
• Wilma Renee Johnson, COTA/L
• Alisa Louise Johnston, LPC, NCC, LSW
• Carey Alan Johnston, D.M.D.
• Priscilla Almond Jolly, D.M.D.
• Adrian Jones
• Kristy Goff Jones, DMD
• Leslie L Jones, M.D.
• Lucy Kay Jones, BCBA, LBA

• All providers in Ridgeland, MS
• Clinical Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.