Individual provider Active NPI

Christina Haire, CSW

  • Clinical Social Worker
  • Bainbridge, GA
National Provider Identifier
1366800013
Registry record updated Feb 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW005643 Issued in GA
Practice address
509 Wheat Ave
Bainbridge, GA 39819-4321
Phone
(229) 416-4421
Fax
(229) 416-4644
NPI assigned
Feb 9, 2016
Last updated
Feb 9, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2016

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 CSW005643 GA Primary

Addresses

Primary practice location

509 Wheat Ave
Bainbridge, GA 39819-4321

Mailing address

509 Wheat Ave
Bainbridge, GA 39819-4321
Phone (229) 416-4421

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
I20160216001979 GA Practitioner - Clinical Social Worker 2365747193 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lifesource of North Carolina Clinical CurrentSince Mar 1, 2021 Accepting new patients
Lifesource of North Carolina Clinical CurrentSince Mar 1, 2021 Accepting new patients
Christina Haire, LCSW, LLC Clinical Current Accepting new patients
Christopher Dennis MD PLLC Clinical CurrentSince Jan 31, 2023 Accepting new patients

Locations

1420 Milstead Rd NE
Conyers, GA 30012
Phone (770) 483-3902

11340 Lakefield Dr
Ste 200
Johns Creek, GA 30097
Phone (678) 407-2159

1345 Redmond Cir NW
Rome, GA 30165
Phone (706) 234-8281

Organizations & group practices 4

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": "1454976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454976000000",
    "number": "1366800013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 WHEAT AVE",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398194321",
            "telephone_number": "229-416-4421",
            "fax_number": "229-416-4644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 WHEAT AVE",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398194321",
            "telephone_number": "229-416-4421",
            "fax_number": "229-416-4644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAIRE",
        "first_name": "CHRISTINA",
        "credential": "CSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-09",
        "last_updated": "2016-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bainbridge, GA

Sources for this page

Verify at the official NPI Registry.