NPIMap

Individual provider Active NPI

Susan Riddle Gordon, LCSW

  • Clinical Social Worker
  • Tifton, GA
National Provider Identifier
1285678359
Registry record updated Dec 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW003185 Issued in GA
Practice address
2402 Tift Ave N
Suite 102
Tifton, GA 31794-1883
Phone
(229) 392-6600
Fax
(229) 382-2181
NPI assigned
Jun 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CSW003185 GA Primary

Addresses

Primary practice location

2402 Tift Ave N
Suite 102
Tifton, GA 31794-1883

Mailing address

2402 Tift Ave N
Suite 102
Tifton, GA 31794-1883
Phone (229) 392-6600

Other identifiers 4

IdentifierTypeStateIssuer
486449509BMedicaidGA
486449509CMedicaidGA
486449509DMedicaidGA
486449509AMedicaidGA

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

LicenseStateTypeSpecialty
CSW003185GAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Authority of Valdosta and Lowndes County, Georgia Past Accepting new patients
South Georgia Psychiatric & Counseling Center Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228176000000",
    "number": "1285678359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2402 TIFT AVE N",
            "address_2": "SUITE 102",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317941883",
            "telephone_number": "229-392-6600",
            "fax_number": "229-382-2181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2402 TIFT AVE N",
            "address_2": "SUITE 102",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317941883",
            "telephone_number": "229-392-6600",
            "fax_number": "229-382-2181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "SUSAN",
        "middle_name": "RIDDLE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2008-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW003185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "486449509B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "486449509C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "486449509D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "486449509A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2008; 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.