Active NPI
Michael Darrell Watson, LICSW
- Clinical Social Worker
- Fort Moore, GA
National Provider Identifier
1104482041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 4808C
- Practice address
- 6600 Van Aalst Blvd
Fort Moore, GA 31905-2102 - Phone
- (762) 408-0374
- NPI assigned
- May 16, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CSW008597 | GA | |
| Clinical Social Worker | 1041C0700X | 4808C | AL | Primary |
Addresses
Primary practice location
6600 Van Aalst Blvd
Fort Moore, GA 31905-2102
Mailing address
141 Cash Dr
Lagrange, GA 30241-8421
Phone (706) 223-8265
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3240 Hospital Dr
Juneau, AK 99801-7808
Phone (907) 796-8435
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4808C | AL | MD | Clinical Social Worker |
| CSW008597 | GA | MD | Clinical Social Worker |
Organizations & group practices 1
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.
-
- Multi-Specialty Clinic/Center
- Juneau, AK
- NPI 1154331734
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740700800000",
"number": "1104482041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "141 CASH DR",
"city": "LAGRANGE",
"state": "GA",
"postal_code": "302418421",
"telephone_number": "706-223-8265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6600 VAN AALST BLVD",
"city": "FORT MOORE",
"state": "GA",
"postal_code": "319052102",
"telephone_number": "762-408-0374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "MICHAEL",
"middle_name": "DARRELL",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-05-16",
"last_updated": "2025-02-28",
"certification_date": "2025-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "CSW008597",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AL",
"license": "4808C",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Moore, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.