Active NPI
Amy Ransom Kincheloe, PHD
- Clinical Child & Adolescent Psychologist
- Atlanta, GA
National Provider Identifier
1922443100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 3628
- Practice address
- 4549 Chamblee Dunwoody Rd
Atlanta, GA 30338-6210 - Phone
- (770) 677-9416
- Fax
- (770) 677-9400
- NPI assigned
- May 1, 2013
- 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 Child & Adolescent Psychologist | 103TC2200X | 3628 | GA | Primary |
Addresses
Primary practice location
4549 Chamblee Dunwoody Rd
Atlanta, GA 30338-6210
Mailing address
4549 Chamblee Dunwoody Rd
Atlanta, GA 30338-6210
Phone (770) 677-9416
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3628 | Other | GA | STATE BOARD OF EXAMINERS (CLINICAL PSYCHOLOGY) |
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 |
|---|---|---|---|
| 3628 | GA | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367366400000",
"number": "1922443100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4549 CHAMBLEE DUNWOODY RD",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303386210",
"telephone_number": "770-677-9416",
"fax_number": "770-677-9400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4549 CHAMBLEE DUNWOODY RD",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303386210",
"telephone_number": "770-677-9416",
"fax_number": "770-677-9400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINCHELOE",
"first_name": "AMY",
"middle_name": "RANSOM",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-01",
"last_updated": "2013-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "GA",
"license": "3628",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE BOARD OF EXAMINERS (CLINICAL PSYCHOLOGY)",
"identifier": "3628",
"state": "GA"
}
],
"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 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.