Active NPI
Carl Dennis Stark, LCSW
- Clinical Social Worker
- Milledgeville, GA
National Provider Identifier
1194827303
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 406
- Practice address
- Highway 60 22 West
Blandyway Office Park
Milledgeville, GA 31061 - Phone
- (478) 445-1290
- Fax
- (478) 445-1296
- NPI assigned
- Sep 1, 2006
- Last updated
- Aug 2, 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 | 406 | GA | Primary |
Addresses
Primary practice location
Highway 60 22 West
Blandyway Office Park
Milledgeville, GA 31061
Mailing address
175 Emery Hwy
Macon, GA 31217-3692
Phone (478) 803-7631
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 406 | Other | GA | LCSW |
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 |
|---|---|---|---|
| 406 | GA | MD | Clinical Social Worker |
| 000406 | GA | MD | Physical Rehabilitation Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343865600000",
"number": "1194827303",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 EMERY HWY",
"city": "MACON",
"state": "GA",
"postal_code": "312173692",
"telephone_number": "478-803-7631",
"fax_number": "478-751-4530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HIGHWAY 60 22 WEST",
"address_2": "BLANDYWAY OFFICE PARK",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "31061",
"telephone_number": "478-445-1290",
"fax_number": "478-445-1296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "CARL",
"middle_name": "DENNIS",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-01",
"last_updated": "2012-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "406",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCSW",
"identifier": "406",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milledgeville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.