Active NPI
Ann Lorene Brock, PSY. D.
- Psychologist
- Riverdale, GA
National Provider Identifier
1659415917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY002481
- Practice address
- 6315 Garden Walk Blvd
Riverdale, GA 30274-2628 - Phone
- (770) 991-7420
- Fax
- (770) 991-7429
- NPI assigned
- Feb 19, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY002481 | GA | Primary |
Addresses
Primary practice location
6315 Garden Walk Blvd
Riverdale, GA 30274-2628
Mailing address
6315 Garden Walk Blvd
Riverdale, GA 30274-2628
Phone (770) 991-7420
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY002481 | GA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clayton Mhddad | Psychologist | 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": "1171843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659415917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6315 GARDEN WALK BLVD",
"city": "RIVERDALE",
"state": "GA",
"postal_code": "302742628",
"telephone_number": "770-991-7420",
"fax_number": "770-991-7429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6315 GARDEN WALK BLVD",
"city": "RIVERDALE",
"state": "GA",
"postal_code": "302742628",
"telephone_number": "770-991-7420",
"fax_number": "770-991-7429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCK",
"first_name": "ANN",
"middle_name": "LORENE",
"name_prefix": "Dr.",
"credential": "PSY. D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "PSY002481",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverdale, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.