Active NPI
Liza Moran Fernandez, LCSW
- Clinical Social Worker
- Tyrone, GA
National Provider Identifier
1013047653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CSW002573
- Practice address
- 120 Handley Rd Ste 310
Tyrone, GA 30290-2173 - Phone
- (404) 644-9244
- Fax
- (770) 632-6351
- NPI assigned
- Mar 6, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | CSW002573 | GA | Primary |
Addresses
Primary practice location
120 Handley Rd Ste 310
Tyrone, GA 30290-2173
Mailing address
104 Kimmer Rd
Peachtree City, GA 30269-3633
Phone (404) 644-9244
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000847569B | Medicaid | GA |
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 |
|---|---|---|---|
| CSW002573 | GA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301529600000",
"number": "1013047653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 KIMMER RD",
"city": "PEACHTREE CITY",
"state": "GA",
"postal_code": "302693633",
"telephone_number": "404-644-9244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 HANDLEY RD STE 310",
"city": "TYRONE",
"state": "GA",
"postal_code": "302902173",
"telephone_number": "404-644-9244",
"fax_number": "770-632-6351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNANDEZ",
"first_name": "LIZA",
"middle_name": "MORAN",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-06",
"last_updated": "2011-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "CSW002573",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000847569B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyrone, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.