NPIMap

Organization Active NPI

Triad Ep, PC

  • Clinical Social Worker
  • Marietta, GA
National Provider Identifier
1386806412
Registry record updated Jan 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW002732 Issued in GA
Legal business name
TRIAD EP, PC
Practice address
316 Alexander St SE
Suite 6
Marietta, GA 30060-2001
Phone
(770) 331-8760
Fax
(678) 581-0146
NPI assigned
Jun 30, 2008
Last updated
Jan 2, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2013

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

Authorized official

Name
Mr. David Glick, LCSW
Title
President
Phone
(770) 331-8760

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X CSW002732 GA Primary

Addresses

Primary practice location

316 Alexander St SE
Suite 6
Marietta, GA 30060-2001

Mailing address

316 Alexander St SE
Suite 6
Marietta, GA 30060-2001
Phone (770) 331-8760

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357084800000",
    "number": "1386806412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 ALEXANDER ST SE",
            "address_2": "SUITE 6",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300602001",
            "telephone_number": "770-331-8760",
            "fax_number": "678-581-0146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 ALEXANDER ST SE",
            "address_2": "SUITE 6",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300602001",
            "telephone_number": "770-331-8760",
            "fax_number": "678-581-0146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD EP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2013-01-02",
        "status": "A",
        "authorized_official_last_name": "GLICK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-331-8760",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW002732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; 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.