DR. GARY EDWARD DUDLEY (PH.D.) – Psychologist, NPI 1710057294

DR. GARY EDWARD DUDLEY (PH.D.) is a healthcare provider. based in Marietta, Georgia. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PH.D.. They hold a License No. PSY000520 (GA). The NPI Number for DR. GARY EDWARD DUDLEY (PH.D.) is 1710057294

Main info

Male
51 Years Of Experience
Accepts Medicare Assignment
Name
DR. GARY EDWARD DUDLEY (PH.D.)
NPI
1710057294
Phone
(770) 953-6401
Address
2520 WINDY HILL RD SE
Enumeration Date
9 November 2006
Last Update Date
8 July 2007

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7709536401
Graduation Year
1975 (51 years ago)
PAC ID
2567640402
Group Practice PAC ID
4587645635
Professional Enrollment ID
I20111208000493
Address ID
GA300678650MA2520XSEXX502
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

483 CLINICAL PSYCHOLOGIST in GA

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Provider Addresses for DR. GARY EDWARD DUDLEY (PH.D.)

  • 2520, Windy Hill Road Southeast, Marietta, Cobb County, Georgia, 30067, United States

    SUITE 203

    MARIETTA, GA 300678664

    Phone: (770) 953-6401

    Fax: (770) 953-6015

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2011-12-08

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20111208000493IClinical PsychologistGATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 30067)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4587645635View full group profile
NameSpecialtyState
Clinical PsychologistGA
Clinical PsychologistGA
Clinical PsychologistGA
Clinical PsychologistGA

Reviews

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Frequently asked questions

Can I use this page to confirm DR. GARY EDWARD DUDLEY (PH.D.)'s NPI?
Yes. DR. GARY EDWARD DUDLEY (PH.D.) is listed with NPI 1710057294 in the public NPI dataset.
Is DR. GARY EDWARD DUDLEY (PH.D.) listed as active for patients and plans?
The listing shows DR. GARY EDWARD DUDLEY (PH.D.) as active in the NPI system.
What is DR. GARY EDWARD DUDLEY (PH.D.)'s specialty?
The listing groups DR. GARY EDWARD DUDLEY (PH.D.) with Psychologist. Clinical services aligned with this taxonomy classification.
Where should I expect DR. GARY EDWARD DUDLEY (PH.D.) on a map?
Expect Marietta, Georgia as a primary anchor for DR. GARY EDWARD DUDLEY (PH.D.) unless the record lists multiple sites.
Is the information about DR. GARY EDWARD DUDLEY (PH.D.) up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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