Active NPI
Shannon Terrell Gordon, LCSW
- Clinical Social Worker
- Forsyth, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CSW001459
- Practice address
- 79 Kyndall LN
Forsyth, GA 31029-8747 - Phone
- (478) 954-6802
- NPI assigned
- Sep 1, 2006
- Last updated
- May 15, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CSW001459 | GA | Primary |
Addresses
Primary practice location
79 Kyndall LN
Forsyth, GA 31029-8747
Mailing address
79 Kyndall LN
Forsyth, GA 31029-8747
Phone (478) 954-6802
Other names 1
- Shannon Terrell Harvey
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CSW001459 | GA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Clinical | Current | Accepting new patients |
| Thriving Lane | Current | Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
200 2nd Ave S
St Petersburg, FL 33701
Phone (727) 465-8515
715 Peachtree St NE
Ste 100
Atlanta, GA 30308
Phone (202) 972-4964
2801 Buford Hwy NE
Ste T10
Brookhaven, GA 30329
Phone (404) 397-8302
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715731200000",
"number": "1306948393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "79 KYNDALL LN",
"city": "FORSYTH",
"state": "GA",
"postal_code": "310298747",
"telephone_number": "478-954-6802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79 KYNDALL LN",
"city": "FORSYTH",
"state": "GA",
"postal_code": "310298747",
"telephone_number": "478-954-6802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "SHANNON",
"middle_name": "TERRELL",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-01",
"last_updated": "2024-05-15",
"certification_date": "2024-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "CSW001459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHANNON",
"last_name": "HARVEY",
"middle_name": "TERRELL",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Forsyth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; 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.