Benjamin J. Edner, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY004502 Issued in GA

Practice address

2308 Perimeter Park Dr Ste 100
Atlanta, GA 30341-1316

Phone

(770) 457-5577

NPI assigned

May 28, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622160000000",
    "number": "1629644885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 E PONCE DE LEON AVE APT B",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302011",
            "telephone_number": "412-527-1666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2308 PERIMETER PARK DR STE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303411316",
            "telephone_number": "770-457-5577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDNER",
        "first_name": "BENJAMIN",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-28",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY004502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott L Ediger, MD
• Stephanie Edlhuber, CPNP
• Ericka M Edmonds, DDS
• Holly Dickson Edmonds, M.D.
• Jillian Edmondson
• Indigo Renesha-Annette Edner, RN
• John Christopher Edney, MD
• Nathaniel O Edoghotu, MD
• Jillian Iyore Edosomwan, MD
• Benjamin Gachelin Edouard, PHARMD

• Psychologist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; 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.