Individual provider Active NPI

Marmaduke Sidney Miles, LCSW

  • Clinical Social Worker
  • Savannah, GA
National Provider Identifier
1356497192
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW002658 Issued in GA
Practice address
23 E 38TH St
Savannah, GA 31401-8560
Phone
(912) 233-1312
Fax
(912) 447-5661
NPI assigned
Jan 26, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 CSW002658 GA Primary

Addresses

Primary practice location

23 E 38TH St
Savannah, GA 31401-8560

Mailing address

23 E 38TH St
Savannah, GA 31401-8560
Phone (912) 233-1312

Other identifiers 1

IdentifierTypeStateIssuer
000847591BMedicaidGA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120813000121 GA Practitioner - Clinical Social Worker 7012163785 Practice locations: Statesboro, GA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of North Carolina at Chapel Hill School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

345 S Walnut St
Statesboro, GA 30458-5496
Phone (912) 272-0933

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
002658GAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
CNW Therapy Consultants, Inc Clinical Past Accepting new patients
Dr. Martha B. Womack, PC Past Accepting new patients
Psychiatric Group of the Coastal Empire, Inc. Past Accepting new patients

Organizations & group practices 3

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": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356497192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 E 38TH ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314018560",
            "telephone_number": "912-233-1312",
            "fax_number": "912-447-5661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 E 38TH ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314018560",
            "telephone_number": "912-233-1312",
            "fax_number": "912-447-5661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILES",
        "first_name": "MARMADUKE",
        "middle_name": "SIDNEY",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW002658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000847591B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.