Individual provider Active NPI

Kelly Delayne Jones, LCSW

  • Clinical Social Worker
  • Valdosta, GA
National Provider Identifier
1023275757
Registry record updated Apr 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW004320 Issued in GA
Practice address
2310 N Patterson St
Suite G
Valdosta, GA 31602-2568
Phone
(229) 244-9688
Fax
(229) 244-5354
NPI assigned
May 20, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2012

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 CSW004320 GA Primary

Addresses

Primary practice location

2310 N Patterson St
Suite G
Valdosta, GA 31602-2568

Mailing address

2310 N Patterson St
Suite G
Valdosta, GA 31602-2568
Phone (229) 244-9688

Other identifiers 1

IdentifierTypeStateIssuer
510380328AMedicaidGA

Other names 1

  • Kelly Delayne Jones Former name

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
I20110303001002 GA Practitioner - Clinical Social Worker 5890977383 Practice locations: Valdosta, GA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1102 Williams St
Valdosta, GA 31601-4041
Phone (229) 588-2266

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
004320GAMDProfessional Counselor
CSW004320GAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335312000000",
    "number": "1023275757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 N PATTERSON ST",
            "address_2": "SUITE G",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022568",
            "telephone_number": "229-244-9688",
            "fax_number": "229-244-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 N PATTERSON ST",
            "address_2": "SUITE G",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022568",
            "telephone_number": "229-244-9688",
            "fax_number": "229-244-5354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "KELLY",
        "middle_name": "DELAYNE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-20",
        "last_updated": "2012-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW004320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "510380328A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "JONES",
            "middle_name": "DELAYNE",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.