Active NPI
Derek James Pickup, LMSW
- Social Worker
- Valdosta, GA
National Provider Identifier
1053657296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 005080
- Practice address
- 807 Blythwood Rd
Valdosta, GA 31602-1666 - Phone
- (229) 251-4638
- NPI assigned
- Dec 17, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 005080 | GA | Primary |
Addresses
Primary practice location
807 Blythwood Rd
Valdosta, GA 31602-1666
Mailing address
807 Blythwood Rd
Valdosta, GA 31602-1666
Phone (229) 251-4638
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005080 | Other | GA | NASW |
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 |
|---|---|---|---|
| 005080 | GA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355702400000",
"number": "1053657296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "807 BLYTHWOOD RD",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316021666",
"telephone_number": "229-251-4638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "807 BLYTHWOOD RD",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316021666",
"telephone_number": "229-251-4638"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICKUP",
"first_name": "DEREK",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-12-17",
"last_updated": "2012-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "GA",
"license": "005080",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NASW",
"identifier": "005080",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Valdosta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.