Sebrina Russell

Primary specialty

Social WorkerTaxonomy code 104100000X

License

MSW007839 Issued in GA

Practice address

409 Arrowhead Blvd Ste C1&C2
Jonesboro, GA 30236-1255

Phone

(404) 391-7675

NPI assigned

Feb 12, 2020

Last updated

Feb 12, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifesource of North CarolinaGroup PAC ID 7416132428, 172 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Lifesource of North Carolina

  dba LifeSource of Georgia

  • General Practice Physician
  • Rome, GA
  • NPI 1962940817
  Medicare reassignment Care Compare group NPD
• Supportive Care of Georgia LLC

  • Clinical Psychologist
  • Roswell, GA
  • NPI 1891362877
  Medicare reassignment
• Lifesource of North Carolina

  • Psychologist
  • Milton, FL
  • NPI 1730648288
  NPD

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

{
    "created_epoch": "1581465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581465600000",
    "number": "1285266734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4305 PAXTON LN SW APT 105",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473390",
            "telephone_number": "601-466-7671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 ARROWHEAD BLVD STE C1&C2",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302361255",
            "telephone_number": "404-391-7675"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2795 Main St W Ste 20B",
            "address_purpose": "LOCATION",
            "city": "Snellville",
            "state": "GA",
            "postal_code": "300783073",
            "country_code": "US",
            "telephone_number": "678-344-7836",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "SEBRINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-12",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "GA",
            "license": "MSW007839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Royal Faith Homecare Agency LLC
• Kerry Lionel Ruffin Sr.
• Geraldine Ruiz
• Eva Lauren Runnels, CRNA
• Sophelia Denise Russ
• S&S Surgical First Assist
• Sag Counseling
• Docile Donna Aguirre Saguan, M.D.
• Andres Salazar, M.D.
• Salutem Healthcare Management

• Social Worker in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.