Active NPI
Ray Joseph Kuckleburg Jr.
- Psychologist
- Atlanta, GA
National Provider Identifier
1750461075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 414
- Practice address
- 1780 Century Blvd NE Ste a
Atlanta, GA 30345-3399 - Phone
- (404) 636-6607
- Fax
- (404) 315-9744
- NPI assigned
- Oct 17, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 414 | GA | Primary |
Addresses
Primary practice location
1780 Century Blvd NE Ste a
Atlanta, GA 30345-3399
Mailing address
1780 Century Blvd NE Ste a
Atlanta, GA 30345-3399
Phone (404) 636-6607
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 |
|---|---|---|---|
| 414 | GA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750461075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1780 CENTURY BLVD NE STE A",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303453399",
"telephone_number": "404-636-6607",
"fax_number": "404-315-9744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1780 CENTURY BLVD NE STE A",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303453399",
"telephone_number": "404-636-6607",
"fax_number": "404-315-9744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUCKLEBURG",
"first_name": "RAY",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, 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.