Active NPI
John B. Jolly, PSY.D.
- Clinical Psychologist
- Ridgeland, MS
National Provider Identifier
1629192083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 33-531
- Practice address
- 740 Avignon Dr Ste B
Ridgeland, MS 39157-5160 - Phone
- (601) 355-8378
- Fax
- (601) 354-5535
- NPI assigned
- Mar 19, 2007
- Last updated
- Nov 9, 2017
- 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 | 33-531 | MS | Primary |
Addresses
Primary practice location
740 Avignon Dr Ste B
Ridgeland, MS 39157-5160
Mailing address
740 Avignon Dr Ste B
Ridgeland, MS 39157-5160
Phone (601) 355-8378
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33-531 | MS | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"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": [],
"endpoints": [],
"other_names": []
}Other providers in Ridgeland, MS
Sources for this page
- 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.