DR. KEITH JAMES FALLON PSY.D.
NPI 1770635401
Psychologist in Conyers, GA

Active since January 16, 2007Accepts Medicare Assignment
1100 GREEN ST SW, CONYERS, GA 30012(404) 502-5824 Get Directions Write a Review

NPPES record last updated: January 21, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Keith James Fallon Psy.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KEITH JAMES FALLON PSY.D. (NPI 1770635401) is an individual psychologist in Conyers, Georgia, licensed in Georgia (PSY002856) and active in the NPI registry since January 2007. He is a graduate of Other (2001).

NPPES Registry Identity

NPI1770635401
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. KEITH JAMES FALLONCredential: PSY.D.
Location Address1100 GREEN ST SWConyers, GA 30012-5220
Mailing AddressPo Box 1790Conyers, GA 30012-7964 · (404) 502-5824
Sole ProprietorNo
Medical School CMSOtherGraduated 2001
Enumeration DateJanuary 16, 2007
Last NPPES UpdateJanuary 21, 2015
NPI 1770635401 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in GA · PSY002856
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
1100 GREEN ST SW, Conyers, GA 30012

Other Identifiers 2

Medicaid375822929BGA
Medicaid375822929AGA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Dr. Keith James Fallon Psy.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7618281510
PECOS Enrollment IDI20150806009919

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Psychologist (Clinical)
1100 GREEN ST SW
CONYERS, GA 30012
Psychologist
1100 GREEN ST SW
CONYERS, GA 30012

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Keith Fallon's NPI number?

The NPI number for Keith Fallon is 1770635401. It was assigned to this individual provider in the NPPES registry on January 16, 2007.

Where is Keith Fallon located?

Keith Fallon practices at 1100 Green St SW, Conyers, GA 30012. The listed phone number is (404) 502-5824.

What is Keith Fallon's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Keith Fallon enrolled in Medicare?

Yes. Keith Fallon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Keith Fallon was last updated on January 21, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.