Individual provider Active NPI

Susan Daughtry Ferrell, PH.D.

  • Clinical Psychologist
  • Metter, GA
National Provider Identifier
1750508370
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
GA001780 Issued in GA
Practice address
66 N Rountree St
Metter, GA 30439-4019
Phone
(912) 685-6259
Fax
(912) 685-9871
NPI assigned
Apr 18, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X GA001780 GA Primary

Addresses

Primary practice location

66 N Rountree St
Metter, GA 30439-4019

Mailing address

PO Box 1146
66 North Rountree Street
Metter, GA 30439-1146
Phone (912) 685-6259

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
1780GAMDAddiction (Substance Use Disorder) Counselor
GA001780GAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
M.J. Martelli, M.D. Past Accepting new patients
Marc W. Eaton, PH.D., P.C. Clinical Past Accepting new patients
Candler Psychological Services Clinical Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750508370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1146",
            "address_2": "66 NORTH ROUNTREE STREET",
            "city": "METTER",
            "state": "GA",
            "postal_code": "304391146",
            "telephone_number": "912-685-6259",
            "fax_number": "912-685-9871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 N ROUNTREE ST",
            "city": "METTER",
            "state": "GA",
            "postal_code": "304394019",
            "telephone_number": "912-685-6259",
            "fax_number": "912-685-9871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERRELL",
        "first_name": "SUSAN",
        "middle_name": "DAUGHTRY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "GA001780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Metter, 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.

Verify at the official NPI Registry.