Active NPI
Kimberly Shawn Underdue, LCSW
- Clinical Social Worker
- Stockbridge, GA
National Provider Identifier
1356575476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CSW004368
- Practice address
- 165 Burke St
Suite 109
Stockbridge, GA 30281-3463 - Phone
- (770) 389-9886
- NPI assigned
- May 4, 2009
- 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 | CSW004368 | GA | Primary |
Addresses
Primary practice location
165 Burke St
Suite 109
Stockbridge, GA 30281-3463
Mailing address
1071 Laurel Ridge Dr
McDonough, GA 30252-8432
Phone (678) 851-9509
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 315091169A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA, MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Clinical | Current | Accepting new patients |
| Underdue Social Services | Past | Accepting new patients | |
| Lucid Lane Providers, P.C. | Clinical | Past | Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
715 Peachtree St NE
Ste 100
Atlanta, GA 30308
Phone (202) 972-4964
250 Monroe Ave NW
Ste 400
Grand Rapids, MI 49503
Phone (616) 441-4616
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.
-
- Exclusive Provider Organization
- Stockbridge, GA
- NPI 1720303092
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292284800000",
"number": "1356575476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1071 LAUREL RIDGE DR",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302528432",
"telephone_number": "678-851-9509",
"fax_number": "678-623-3748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 BURKE ST",
"address_2": "SUITE 109",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302813463",
"telephone_number": "770-389-9886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UNDERDUE",
"first_name": "KIMBERLY",
"middle_name": "SHAWN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-05-04",
"last_updated": "2010-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "CSW004368",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "315091169A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stockbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2010; 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.