Active NPI
Tairesha S Rucker, LMSW
- Social Worker
- Kennesaw, GA
National Provider Identifier
1144966110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- MSW008598
- Practice address
- 1309 Wood Park Dr NW
Kennesaw, GA 30152-4640 - Phone
- (912) 777-8790
- NPI assigned
- May 11, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | MSW008598 | GA | Primary |
Addresses
Primary practice location
1309 Wood Park Dr NW
Kennesaw, GA 30152-4640
Mailing address
1309 Wood Park Dr NW
Kennesaw, GA 30152-4640
Phone (912) 777-8790
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 |
|---|---|---|---|
| MSW008598 | GA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652227200000",
"number": "1144966110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1309 WOOD PARK DR NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301524640",
"telephone_number": "912-777-8790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1309 WOOD PARK DR NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301524640",
"telephone_number": "912-777-8790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUCKER",
"first_name": "TAIRESHA",
"middle_name": "S",
"name_prefix": "Miss",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-11",
"last_updated": "2022-05-11",
"certification_date": "2022-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "GA",
"license": "MSW008598",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.