Individual provider Active NPI

Janice Nixon

  • Professional Counselor
  • Columbus, GA
National Provider Identifier
1366691271
Registry record updated Jun 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC004000 Issued in GA
Practice address
5617 Princeton Ave
Columbus, GA 31904-3480
Phone
(706) 257-7722
Fax
(706) 257-7723
NPI assigned
Sep 16, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 003989 GA
Professional Counselor 101YP2500X LPC004000 GA Primary

Addresses

Primary practice location

5617 Princeton Ave
Columbus, GA 31904-3480

Mailing address

6315 N Tyler CT
Columbus, GA 31909-4232
Phone (912) 532-3889

Other identifiers 1

IdentifierTypeStateIssuer
1700244415MedicaidGA

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
I20240725004458 GA Practitioner - Mental Health Counselor 2860938834 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
003989GAMDMental Health Counselor
LPC004000GAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Mental Health CurrentSince Jun 14, 2024 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

Organizations & group practices 1

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": "1221523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591056000000",
    "number": "1366691271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6315 N TYLER CT",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319094232",
            "telephone_number": "912-532-3889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5617 PRINCETON AVE",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319043480",
            "telephone_number": "706-257-7722",
            "fax_number": "706-257-7723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIXON",
        "first_name": "JANICE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-16",
        "last_updated": "2020-06-02",
        "certification_date": "2020-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "003989",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC004000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700244415",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

Verify at the official NPI Registry.