Justin Gordon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW005873 Issued in GA

Practice address

6624 Jimmy Carter Blvd Ste a
Peachtree Corners, GA 30071-1727

Phone

(404) 900-5450

Fax

(404) 900-5453

NPI assigned

Jun 5, 2017

Last updated

Jun 5, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Willow Oak Community Behavioral Health Center

  dba Willow Oak Center

  • Community/Behavioral Health Agency
  • Newnan, GA
  • NPI 1881131860
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, GA

  Medicare reassignment NPD
• Willow Oak Foundation, Inc.

  • Community/Behavioral Health Agency
  • Newnan, GA
  • NPI 1588273528
  NPD (past)

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

{
    "created_epoch": "1496620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496620800000",
    "number": "1265961205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6624 JIMMY CARTER BLVD STE A",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300711727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6624 JIMMY CARTER BLVD STE A",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300711727",
            "telephone_number": "404-900-5450",
            "fax_number": "404-900-5453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JUSTIN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-05",
        "last_updated": "2017-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER",
            "identifier": "CSW005873",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crysta Marie Giles, RN
• Hannah Glass
• Ashley Noelle Gleason
• Catecia Montae Godbee, LCSW
• Adriana Gonzalez
• Julian Gorvy, M.D.
• Ashley Smith Gottschalk, BCCC
• Anna Julia Gowasack, MS
• Grace Midwifery & Women's Health
• Gia S. Grannum, DMD

• Clinical Social Worker in Peachtree Corners, GA
• Providers in Peachtree Corners, 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 Jun 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.