Michele Suzanne Wagner, CSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW004260 Issued in GA

Practice address

2900 Chamblee Tucker Rd
BLD 8, Ste 301
Atlanta, GA 30341-4100

Phone

(678) 824-6590

Fax

(678) 824-6597

NPI assigned

May 30, 2011

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• All Source Professionals, LLC

  • Developmentally Disabled Services Day Training Agency
  • Lithonia, GA
  • NPI 1053612077
  NPD (past)
• Gye Nyame Therapeutic Counseling

  • Community/Behavioral Health Agency
  • Atlanta, GA
  • NPI 1942565346
  NPD (past)

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

{
    "created_epoch": "1306713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306713600000",
    "number": "1083908735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8075 MALL PKWY",
            "address_2": "STE 101-348",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300386993",
            "telephone_number": "678-288-6550",
            "fax_number": "800-609-0965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 CHAMBLEE TUCKER RD",
            "address_2": "BLD 8, STE 301",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303414100",
            "telephone_number": "678-824-6590",
            "fax_number": "678-824-6597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MICHELE",
        "middle_name": "SUZANNE",
        "credential": "CSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-30",
        "last_updated": "2011-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW004260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric R Wagner, MD
• Hannah Wagner
• John David Wagner, MD
• Kimberly Marie Wagner, AT
• Lynn Wagner, MA, LPC
• Myesha J. Wagner, FNP-C
• Rebecca Nancy Wagner
• Riley Ann Wagner, OT
• Samantha Wagner, MD
• Tarah Wagner

• Clinical Social Worker in Atlanta, GA
• Providers in Atlanta, 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 May 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.