Active NPI
Jennifer E Fennell, PSYD
- Clinical Psychologist
- Norcross, GA
National Provider Identifier
1881963437
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY003407
- Practice address
- 4530 South Berkeley Lake Road
Norcross, GA 30071 - Phone
- (770) 446-5642
- Fax
- (770) 446-5643
- NPI assigned
- Dec 27, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY003407 | GA | Primary |
Addresses
Primary practice location
4530 South Berkeley Lake Road
Norcross, GA 30071
Mailing address
4530 South Berkeley Lake Road
Norcross, GA 30071
Phone (770) 446-5642
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 |
|---|---|---|---|
| PSY003407 | GA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324944000000",
"number": "1881963437",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4530 SOUTH BERKELEY LAKE ROAD",
"city": "NORCROSS",
"state": "GA",
"postal_code": "30071",
"telephone_number": "770-446-5642",
"fax_number": "770-446-5643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4530 SOUTH BERKELEY LAKE ROAD",
"city": "NORCROSS",
"state": "GA",
"postal_code": "30071",
"telephone_number": "770-446-5642",
"fax_number": "770-446-5643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENNELL",
"first_name": "JENNIFER",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-27",
"last_updated": "2011-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY003407",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norcross, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.