NPIMap

Organization Active NPI

Kennridge Psychological Associates

  • Clinical Psychologist
  • Sandy Springs, GA
National Provider Identifier
1780716258
Registry record updated May 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3552 Issued in GA
Legal business name
KENNRIDGE PSYCHOLOGICAL ASSOCIATES
Practice address
6065 Roswell Road
Suite 725
Sandy Springs, GA 30328-4043
Phone
(770) 956-9213
Fax
(770) 956-9218
NPI assigned
Mar 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2012

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

Authorized official

Name
Dr. Charles A. Jenkins, PSY.DNPI 1912048356
Title
President
Phone
(770) 956-9213

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 1582 GA
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 3552 GA Primary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 818 GA

Addresses

Primary practice location

6065 Roswell Road
Suite 725
Sandy Springs, GA 30328-4043

Mailing address

6065 Roswell Rd
Suite 725
Sandy Springs, GA 30328-4043
Phone (770) 956-9213

National Provider Directory

National Provider Directory

Locations

6065 Roswell Rd
Ste 725
Sandy Springs, GA 30328
Phone (770) 956-9213

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336953600000",
    "number": "1780716258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6065 ROSWELL RD",
            "address_2": "SUITE 725",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303284043",
            "telephone_number": "770-956-9213",
            "fax_number": "770-956-9218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6065 ROSWELL ROAD",
            "address_2": "SUITE 725",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303284043",
            "telephone_number": "770-956-9213",
            "fax_number": "770-956-9218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNRIDGE PSYCHOLOGICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-11",
        "last_updated": "2012-05-14",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-956-9213",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "GA",
            "license": "1582",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "3552",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "818",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy Springs, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.