Active NPI
Eileen Brody Shaw, LC, LAPC
- Professional Counselor
- Atlanta, GA
National Provider Identifier
1003195900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- APC002229
- Practice address
- 4536 Barclay Dr
Suite a
Atlanta, GA 30338-7145 - Phone
- (770) 458-8711
- Fax
- (770) 458-8640
- NPI assigned
- Aug 9, 2011
- Last updated
- Aug 9, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | APC002229 | GA | Primary |
| Registered Dietitian | 133V00000X | LD000428 | GA |
Addresses
Primary practice location
4536 Barclay Dr
Suite a
Atlanta, GA 30338-7145
Mailing address
4536 Barclay Drive
Suite a
Atlanta, GA 30338
Phone (770) 458-8711
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 |
|---|---|---|---|
| APC002229 | GA | MD | Professional Counselor |
| LD000428 | GA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlanta Center for Eating Disorders | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312848000000",
"number": "1003195900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4536 BARCLAY DRIVE",
"address_2": "SUITE A",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30338",
"telephone_number": "770-458-8711",
"fax_number": "770-458-8640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4536 BARCLAY DR",
"address_2": "SUITE A",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303387145",
"telephone_number": "770-458-8711",
"fax_number": "770-458-8640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "EILEEN",
"middle_name": "BRODY",
"credential": "LC, LAPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-09",
"last_updated": "2011-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "APC002229",
"primary": true
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "LD000428",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.