Khaalida Tahira Forbes, LICSW, PHD

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW005158 Issued in GA

Practice address

4650 Flat Shoals Pkwy
Decatur, GA 30034-5000

Phone

(404) 243-9336

Fax

(404) 212-1265

NPI assigned

Aug 1, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Khaalida Tahira Smalls Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411430400000",
    "number": "1265710743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 FLAT SHOALS PKWY",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300345000",
            "telephone_number": "404-243-9336",
            "fax_number": "404-212-1265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 FLAT SHOALS PKWY",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300345000",
            "telephone_number": "404-243-9336",
            "fax_number": "404-212-1265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORBES",
        "first_name": "KHAALIDA",
        "middle_name": "TAHIRA",
        "name_prefix": "Dr.",
        "credential": "LICSW, PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-01",
        "last_updated": "2014-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "16810",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005158",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC50078804",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KHAALIDA",
            "last_name": "SMALLS",
            "middle_name": "TAHIRA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Alicia Fong, DDS
• Emma Byrne Fontenot
• Foot Solutions of Georgia
• Jacqueline Harrison Foote, LMSW
• Karen Charisse Forbes, PA-C
• Christine Ford-Jackson, L.P.N.
• Felicia Marguerite Ford, MS, ATC
• Kimberly A. Ford, LCSW
• Laquanta Ford, LCSW
• Lasonya Renise Ford, PHARM.D., BCACP

• Clinical Social Worker in Decatur, GA
• Providers in Decatur, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; 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.