Provider Demographics
NPI:1508469537
Name:SHIFRIN, JAYLYN CLARK (PHD)
Entity type:Individual
Prefix:DR
First Name:JAYLYN
Middle Name:CLARK
Last Name:SHIFRIN
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 HARVEST MOON TRCE SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2468
Mailing Address - Country:US
Mailing Address - Phone:229-977-0834
Mailing Address - Fax:
Practice Address - Street 1:3355 LENOX RD NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1332
Practice Address - Country:US
Practice Address - Phone:770-284-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004638103T00000X, 103T00000X
NC5826103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5826OtherNORTH CAROLINA PSYCHOLOGY BOARD