Active NPI
Shamicka L Cannon, LMSW
- Clinical Social Worker
- Germantown, TN
National Provider Identifier
1124625041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 13442
- Practice address
- 2158 Judicial Dr
Germantown, TN 38138-3823 - Phone
- (901) 571-8911
- NPI assigned
- Oct 4, 2020
- Sex
- Female
- 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 | M9755 | MS | |
| Clinical Social Worker | 1041C0700X | 13442 | TN | Primary |
Addresses
Primary practice location
2158 Judicial Dr
Germantown, TN 38138-3823
Mailing address
10942 Lexington Dr
Olive Branch, MS 38654-9317
Phone (662) 804-7570
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 |
|---|---|---|---|
| M9755 | MS | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727308800000",
"number": "1124625041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10942 LEXINGTON DR",
"city": "OLIVE BRANCH",
"state": "MS",
"postal_code": "386549317",
"telephone_number": "662-804-7570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2158 JUDICIAL DR",
"city": "GERMANTOWN",
"state": "TN",
"postal_code": "381383823",
"telephone_number": "901-571-8911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "SHAMICKA",
"middle_name": "L",
"name_prefix": "Ms.",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-04",
"last_updated": "2024-09-26",
"certification_date": "2024-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MS",
"license": "M9755",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TN",
"license": "13442",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Germantown, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.