Stephanie Leedy-Ellis, PH.D., LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1688 Issued in GA

Legal business name

STEPHANIE LEEDY-ELLIS, PH.D., LLC

Practice address

3949 Holcomb Bridge Rd
Suite 200
Norcross, GA 30092-2207

Phone

(404) 231-3364

Fax

(770) 813-7446

NPI assigned

May 11, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Stephanie Leedy-Ellis, PH.D.

Title

Manager

Phone

(404) 231-3364

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313107200000",
    "number": "1962617183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3949 HOLCOMB BRIDGE RD",
            "address_2": "SUITE 200",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300922207",
            "telephone_number": "404-231-3364",
            "fax_number": "770-813-7446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3949 HOLCOMB BRIDGE RD",
            "address_2": "SUITE 200",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300922207",
            "telephone_number": "404-231-3364",
            "fax_number": "770-813-7446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHANIE LEEDY-ELLIS, PH.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2011-08-12",
        "status": "A",
        "authorized_official_last_name": "LEEDY-ELLIS",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "404-231-3364",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "GA",
            "license": "1688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL PROVIDER NPI",
            "identifier": "1447346101",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Norcross, GA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.

Verify at the official NPI Registry.