Active NPI
Witni Jackson
- Clinical Social Worker
- Jonesboro, GA
National Provider Identifier
1083028112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CSW004999
- Practice address
- 853 Battlecreek Rd
Jonesboro, GA 30236-1919 - Phone
- (770) 478-1099
- Fax
- (770) 478-8722
- NPI assigned
- Jun 17, 2014
- Sex
- Female
- Sole proprietor
- No
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 | CSW004999 | GA | Primary |
Addresses
Primary practice location
853 Battlecreek Rd
Jonesboro, GA 30236-1919
Mailing address
853 Battlecreek Rd
Jonesboro, GA 30236-1919
Phone (770) 478-1099
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 |
|---|---|---|---|
| CSW004999 | GA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402963200000",
"number": "1083028112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "853 BATTLECREEK RD",
"city": "JONESBORO",
"state": "GA",
"postal_code": "302361919",
"telephone_number": "770-478-1099",
"fax_number": "770-478-8722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "853 BATTLECREEK RD",
"city": "JONESBORO",
"state": "GA",
"postal_code": "302361919",
"telephone_number": "770-478-1099",
"fax_number": "770-478-8722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "WITNI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-17",
"last_updated": "2014-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "CSW004999",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.