Individual provider Active NPI

Eterica Dionne Sims-Rucks, LCSW

  • Clinical Social Worker
  • Atlanta, GA
National Provider Identifier
1366772485
Registry record updated Oct 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW004169 Issued in GA
Practice address
3113 Abbey Dr SW
Atlanta, GA 30331-5477
Phone
(404) 423-5900
Fax
(866) 830-7199
NPI assigned
Jan 12, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 14, 2012

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 CSW004169 GA Primary

Addresses

Primary practice location

3113 Abbey Dr SW
Atlanta, GA 30331-5477

Mailing address

3485 N Desert Dr # 205
East Point, GA 30344-5724
Phone (404) 721-6716

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

NPI Registry JSON

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

{
    "created_epoch": "1263254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350172800000",
    "number": "1366772485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3485 N DESERT DR # 205",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303445724",
            "telephone_number": "404-721-6716",
            "fax_number": "866-830-7199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3113 ABBEY DR SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303315477",
            "telephone_number": "404-423-5900",
            "fax_number": "866-830-7199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMS-RUCKS",
        "first_name": "ETERICA",
        "middle_name": "DIONNE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-12",
        "last_updated": "2012-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW004169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2012; 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.