Active NPI
Delores Yvonne Spencer-Izegbu, E.D.
- School Psychologist
- Conyers, GA
National Provider Identifier
1972376069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 301603
- Practice address
- 2528 Meadowmist PL SE
Conyers, GA 30013-6314 - Phone
- (404) 271-4934
- NPI assigned
- Nov 1, 2023
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 301603 | GA | Primary |
Addresses
Primary practice location
2528 Meadowmist PL SE
Conyers, GA 30013-6314
Mailing address
2528 Meadowmist PL SE
Conyers, GA 30013-6314
Phone (404) 271-4934
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 |
|---|---|---|---|
| 301603 | GA | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698796800000",
"number": "1972376069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2528 MEADOWMIST PL SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300136314",
"telephone_number": "404-271-4934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2528 MEADOWMIST PL SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300136314",
"telephone_number": "404-271-4934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPENCER-IZEGBU",
"first_name": "DELORES",
"middle_name": "YVONNE",
"name_prefix": "Dr.",
"credential": "E.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-11-01",
"last_updated": "2023-11-01",
"certification_date": "2023-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, School",
"state": "GA",
"license": "301603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.