Beaufort Addison III

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

5576 Oak Bend PL
Lithonia, GA 30058-3302

Phone

(803) 664-4007

NPI assigned

Mar 25, 2021

Sex

Male

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rising Hope Clinical Assistance, LLC

  • Community/Behavioral Health Agency
  • Columbus, OH
  • NPI 1669896130
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 25, 2021.

{
    "created_epoch": "1616630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1205413481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5576 OAK BEND PL",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300583302",
            "telephone_number": "803-664-4007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5576 OAK BEND PL",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300583302",
            "telephone_number": "803-664-4007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 S 3rd St",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432154206",
            "country_code": "US",
            "telephone_number": "614-726-1485",
            "fax_number": "866-416-1767",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1755 The Exchange SE Ste 330U",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303397434",
            "country_code": "US",
            "telephone_number": "678-273-3005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADDISON",
        "first_name": "BEAUFORT",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-25",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://sharenote.com",
            "affiliation": "Y",
            "affiliationName": "Rising Hope Clinical Assistance, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1755 The Exchange SE Ste 330U",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303397434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in Lithonia, GA
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.