Active NPI
Glen Gaugh, LMSW
- Clinical Social Worker
- Jackson, TN
National Provider Identifier
1003321902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 9206
- Practice address
- 24 Weatherford SQ
Jackson, TN 38305-2202 - Phone
- (731) 660-6730
- NPI assigned
- Dec 13, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 9206 | TN | Primary |
Addresses
Primary practice location
24 Weatherford SQ
Jackson, TN 38305-2202
Mailing address
24 Weatherford SQ
Jackson, TN 38305-2202
Phone (731) 660-6730
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9206 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513123200000",
"number": "1003321902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 WEATHERFORD SQ",
"city": "JACKSON",
"state": "TN",
"postal_code": "383052202",
"telephone_number": "731-660-6730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 WEATHERFORD SQ",
"city": "JACKSON",
"state": "TN",
"postal_code": "383052202",
"telephone_number": "731-660-6730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAUGH",
"first_name": "GLEN",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-13",
"last_updated": "2017-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TN",
"license": "9206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.