Shane Sumner, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW006484 Issued in GA

Practice address

1091 McRees Mill Rd
Watkinsville, GA 30677-2960

Phone

(706) 765-7377

NPI assigned

Aug 11, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1628640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628640000000",
    "number": "1336814342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1091 MCREES MILL RD",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306772960",
            "telephone_number": "706-765-7377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1091 MCREES MILL RD",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306772960",
            "telephone_number": "706-765-7377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMNER",
        "first_name": "SHANE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-11",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW006484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Watkinsville",
            "affiliation": "N",
            "endpointDescription": "Cell phone",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1091 McRees Mill Rd",
            "city": "Watkinsville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "306772960",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Alisa Dawn Stula
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• Sunshine Pediatrics PC
• Amy Swingle
• Virginia Synan, NCC
• Nathan King Szakal, PA

• Clinical Social Worker in Watkinsville, GA
• Providers in Watkinsville, 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 Aug 11, 2021; 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.