Active NPI
Manuel Sanchez- Mejorada, LCSW
- Clinical Social Worker
- Decatur, GA
National Provider Identifier
1124376967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CSW004309
- Practice address
- 1814 Clairmont Rd
Decatur, GA 30033-3405 - Phone
- (404) 636-1457
- NPI assigned
- Aug 28, 2012
- Sex
- Male
- 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 | CSW004309 | GA | Primary |
Addresses
Primary practice location
1814 Clairmont Rd
Decatur, GA 30033-3405
Mailing address
1814 Clairmont Rd
Decatur, GA 30033-3405
Phone (404) 636-1457
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 580899552 | Other | GA | CCCG ID |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CSW004309 | GA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346112000000",
"number": "1124376967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1814 CLAIRMONT RD",
"city": "DECATUR",
"state": "GA",
"postal_code": "300333405",
"telephone_number": "404-636-1457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1814 CLAIRMONT RD",
"city": "DECATUR",
"state": "GA",
"postal_code": "300333405",
"telephone_number": "404-636-1457"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANCHEZ- MEJORADA",
"first_name": "MANUEL",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-28",
"last_updated": "2012-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "CSW004309",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CCCG ID",
"identifier": "580899552",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.