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NPI Code Detail

MEDICARE: DR. JEREMY SEAN MCKAY PH.D

MEDICARE: DR. JEREMY SEAN MCKAY PH.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY002848GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
152048822OTHERGABCBS OF GA
2557529-000OTHERGAMAGELLAN MIS NUMBER
3557529000OTHERGAMAGELLAN/WELLCARE ID
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5103463OTHERGACENPATICO BEHAVIORAL HEAL

General Provider Information

NPI Number : 1043397474
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREMY SEAN MCKAY PH.D
Provider Business Mailing Address
First Line : 516 RIDLEY AVE
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2234
Country : US
Telephone Number : 706-845-1601
Fax Number : 706-845-8510
Provider Business Practice Location Address
First Line : 17273 STATE ROUTE 104
Second Line :
City : CHILLICOTHEE
State : OH
Zip : 45601-9718
Country : US
Telephone Number : 740-773-1141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 06/05/2026

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