Stephanie Blackett Nichols, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW005084 Issued in GA

Practice address

3540 Wheeler Rd
Suite 619
Augusta, GA 30909-1871

Phone

(706) 733-0333

NPI assigned

Mar 16, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956
  Medicare reassignment NPD
• Mindful Therapy Works, LLC

  • Clinical Social Worker
  • Atlanta, GA
  • NPI 1811537558
  NPD Authorized official

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

{
    "created_epoch": "1426464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433980800000",
    "number": "1053704072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 WHEELER RD",
            "address_2": "SUITE 619",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309091871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 WHEELER RD",
            "address_2": "SUITE 619",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309091871",
            "telephone_number": "706-733-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "STEPHANIE",
        "middle_name": "BLACKETT",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-16",
        "last_updated": "2015-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Billy Michael Nichols, MD
• Charles William Nichols Jr., PH.D.
• Fenwick T. Nichols, MD
• Lisa Nichols, ATC
• Martha Easler Nichols, MD
• Brianna Taylor Nicholson
• Lee Anna Melissa Nicholson
• Matthew Steven Nicholson, M.D.
• Nestor L. Nieves, MD
• Mustafa Musa Nimir, MD

• Clinical Social Worker in Augusta, GA
• Providers in Augusta, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; 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.

Verify at the official NPI Registry.