Individual provider Active NPI

Brandi Michelle Williams, LCSW

  • Clinical Social Worker
  • Conyers, GA
National Provider Identifier
1013516608
Registry record updated Oct 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
1808 Over Lake Dr SE Ste D
Conyers, GA 30013-6608
Phone
(678) 213-2194
NPI assigned
Oct 23, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

1808 Over Lake Dr SE Ste D
Conyers, GA 30013-6608

Mailing address

4255 Wade Green Rd NW Ste 414
Kennesaw, GA 30144-1763

Other practice location 1

1838 Old Norcross Rd Ste 400
Lawrenceville, GA 30044-8804
Phone (678) 213-2194

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210812000835 GA Practitioner - Clinical Social Worker 2466856497 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Personal Recovery Network LLCGroup PAC ID 5092611384, 612 clinicians

Practice addresses (Care Compare)

1808 Over Lake Dr SE
Suite D
Conyers, GA 30013-6608
Phone (678) 213-2194

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Personal Recovery Network LLC CurrentSince Aug 1, 2021 Accepting new patients

Locations

1808 Over Lake Dr SE
Ste D
Conyers, GA 30013
Phone (770) 648-1308

4255 Wade Green Rd NW
Ste 414
Kennesaw, GA 30144
Phone (678) 439-9952

1838 Old Norcross Rd
Ste 400
Lawrenceville, GA 30044
Phone (470) 795-7695

250 Corporate Center Ct
Stockbridge, GA 30281
Phone (770) 954-8685

Networks

  • FL HMO C-SNP
  • FL HMO

Interoperability endpoints

  • Direct secure messaging: georgiabehavioralhealthprofessionals.brandiwilliams@124220.advancedmd-direct.com

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1013516608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4255 WADE GREEN RD NW STE 414",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301441763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 OVER LAKE DR SE STE D",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300136608",
            "telephone_number": "678-213-2194"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1838 Old Norcross Rd Ste 400",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300448804",
            "country_code": "US",
            "telephone_number": "678-213-2194",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "BRANDI",
        "middle_name": "MICHELLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-23",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

Verify at the official NPI Registry.