Jeremy Houston Noles

Key facts

NPI

1154027902

Entity type

Individual (NPI type 1)

Primary specialty

Social Worker 104100000X

License

MSW010891 (GA)

Practice address

546 Barron Dr
Clarkesville, GA 30523-5502

Phone

(706) 768-1620

NPI assigned

Feb 3, 2023

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 3, 2023.

{
    "created_epoch": "1675382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675382400000",
    "number": "1154027902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "546 BARRON DR",
            "city": "CLARKESVILLE",
            "state": "GA",
            "postal_code": "305235502",
            "telephone_number": "706-768-1620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "546 BARRON DR",
            "city": "CLARKESVILLE",
            "state": "GA",
            "postal_code": "305235502",
            "telephone_number": "706-768-1620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOLES",
        "first_name": "JEREMY",
        "middle_name": "HOUSTON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-02-03",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "GA",
            "license": "MSW010891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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