Individual provider Active NPI

Gaynell Denise Hill, LCSW, MAC

  • Clinical Social Worker
  • Mountain Home AFB, ID
National Provider Identifier
1366772253
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW004147 Issued in GA
Practice address
90 Hope Dr BLDG 6000
Mountain Home AFB, ID 83648-1062
Phone
(912) 536-1643
NPI assigned
Dec 28, 2009
Last updated
Jan 6, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

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 CSW004147 GA Primary

Addresses

Primary practice location

90 Hope Dr BLDG 6000
Mountain Home AFB, ID 83648-1062

Mailing address

90 Hope Dr BLDG 6000
Mountain Home AFB, ID 83648-1062
Phone (912) 536-1643

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
I20100309000237 GA Practitioner - Clinical Social Worker 3870638364 Reassigns benefits to 2 organizations
Practice locations: Statesboro, GA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mental Health Specialty Group PA CurrentSince May 1, 2025 Accepting new patients
Personal Recovery Network LLC CurrentSince Feb 13, 2023 Accepting new patients
Senior Psych Solutions Corp Clinical Past Accepting new patients
Jenkins County Hospital LLC Past Accepting new patients
Gaynell Denise Hill, LCSW Clinical PastSince Sep 10, 2022 Accepting new patients

Locations

3424 Peachtree Rd NE
Ste 2200
Atlanta, GA 30326
Phone (404) 436-2563

3633 Wheeler Rd
Ste 365
Augusta, GA 30909
Phone (706) 432-6866

4039 Gateway Blvd
Grovetown, GA 30813
Phone (706) 498-9570

250 Corporate Center Ct
Stockbridge, GA 30281
Phone (770) 954-8685

Organizations & group practices 5

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": "1261958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1366772253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 HOPE DR BLDG 6000",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481062",
            "telephone_number": "912-536-1643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 HOPE DR BLDG 6000",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481062",
            "telephone_number": "912-536-1643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HILL",
        "first_name": "GAYNELL",
        "middle_name": "DENISE",
        "credential": "LCSW, MAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-28",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW004147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Home AFB, ID

Sources for this page

Verify at the official NPI Registry.