NPIMap

Organization Active NPI

Judy & Bruce Pemberton, LLC

  • Clinical Psychologist
  • Atlanta, GA
National Provider Identifier
1750642419
Registry record updated May 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY001100 Issued in GA
Legal business name
JUDY & BRUCE PEMBERTON, LLC
Practice address
1145 Sheridan Rd NE
Atlanta, GA 30324-3714
Phone
(404) 325-8512
Fax
(404) 325-8733
NPI assigned
May 30, 2012
Last updated
May 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2012

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

Authorized official

Name
Judy Pemberton, PH.D.NPI 1427198217
Title
Owner
Phone
(404) 325-8512

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY001100 GA Primary

Addresses

Primary practice location

1145 Sheridan Rd NE
Atlanta, GA 30324-3714

Mailing address

1130 Piedmont Ave NE
Suite 1502
Atlanta, GA 30309-3780
Phone (404) 325-8512

National Provider Directory

National Provider Directory

Locations

1145 Sheridan Rd NE
Atlanta, GA 30324
Phone (404) 325-0304

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1338336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338336000000",
    "number": "1750642419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 PIEDMONT AVE NE",
            "address_2": "SUITE 1502",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303093780",
            "telephone_number": "404-325-8512",
            "fax_number": "404-325-8733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 SHERIDAN RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303243714",
            "telephone_number": "404-325-8512",
            "fax_number": "404-325-8733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUDY & BRUCE PEMBERTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-30",
        "last_updated": "2012-05-30",
        "status": "A",
        "authorized_official_last_name": "PEMBERTON",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-325-8512",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY001100",
            "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 May 30, 2012; 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.