Active NPI
Jason M. Nelson, PH.D.
- Psychologist
- Athens, GA
National Provider Identifier
1811319403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3266
- Practice address
- 105A Cedar Rock Trace
Suite 5
Athens, GA 30605 - Phone
- (706) 548-8697
- Fax
- (706) 548-8698
- NPI assigned
- Jan 15, 2014
- 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 | 3266 | GA | Primary |
Addresses
Primary practice location
105A Cedar Rock Trace
Suite 5
Athens, GA 30605
Mailing address
1041 Creek Farm Run
Bogart, GA 30622-2791
Phone (706) 612-4947
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
| License | State | Type | Specialty |
|---|---|---|---|
| 3266 | GA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675296000000",
"number": "1811319403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1041 CREEK FARM RUN",
"city": "BOGART",
"state": "GA",
"postal_code": "306222791",
"telephone_number": "706-612-4947",
"fax_number": "706-548-8698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105A CEDAR ROCK TRACE",
"address_2": "SUITE 5",
"city": "ATHENS",
"state": "GA",
"postal_code": "30605",
"telephone_number": "706-548-8697",
"fax_number": "706-548-8698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "JASON",
"middle_name": "M.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-15",
"last_updated": "2023-02-02",
"certification_date": "2023-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "3266",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.