Active NPI
Denise Glanville, PH.D.
- Clinical Psychologist
- Decatur, GA
National Provider Identifier
1891851051
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY003074
- Practice address
- 315 W Ponce de Leon Ave
Suite 1051
Decatur, GA 30030-2400 - Phone
- (404) 378-0441
- NPI assigned
- Dec 29, 2006
- Last updated
- Oct 7, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | PSY003074 | GA | |
| Clinical Psychologist | 103TC0700X | PSY003074 | GA | Primary |
| Clinical Psychologist | 103TC0700X | 04127 | MD | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | PSY003074 | GA |
Addresses
Primary practice location
315 W Ponce de Leon Ave
Suite 1051
Decatur, GA 30030-2400
Mailing address
3316 S Cobb Dr SE Ste a
Suite 324
Smyrna, GA 30080-4107
Phone (404) 966-7505
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04127 | MD | MD | Clinical Psychologist |
Organizations & group practices 1
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": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286409600000",
"number": "1891851051",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3316 S COBB DR SE STE A",
"address_2": "SUITE 324",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300804107",
"telephone_number": "404-966-7505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 W PONCE DE LEON AVE",
"address_2": "SUITE 1051",
"city": "DECATUR",
"state": "GA",
"postal_code": "300302400",
"telephone_number": "404-378-0441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLANVILLE",
"first_name": "DENISE",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-29",
"last_updated": "2010-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "GA",
"license": "PSY003074",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY003074",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "04127",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "GA",
"license": "PSY003074",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.