Willie James Campbell, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW004685 Issued in GA

Practice address

1345 Redmond Cir NW
Rome, GA 30165-1307

Phone

(910) 742-9243

Fax

(888) 746-1787

NPI assigned

May 17, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, KY, FL, NC, DC, MD, VA7 enrollments

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 7

Specialty

Clinical Social Worker

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Axis Healthcare Group 76 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: willie.campbell.1@30520.direct.athenahealth.com

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.

• Axis Healthcare Group

  • Psychiatry Physician
  • Silver Spring, MD
  • NPI 1326295098

  DC, MD

  Medicare reassignment Care Compare group NPD
• Lifesource of North Carolina

  • General Practice Physician
  • Rome, GA
  • NPI 1962940817

  Clinical, GA

  Medicare reassignment NPD
• Backpack Medical Group, P.C.

  • Clinical Social Worker
  • Elkridge, MD
  • NPI 1851177570

  Clinical, MD, VA

  Medicare reassignment NPD
• Lavni, Inc

  • Community/Behavioral Health Agency
  • Henderson, NC
  • NPI 1215673256

  GA

  Medicare reassignment NPD
• Lifesource of North Carolina

  • Clinical Social Worker
  • Pikeville, KY
  • NPI 1538728183

  Clinical, KY

  Medicare reassignment NPD
• MCS, PC

  • Community/Behavioral Health Agency
  • Silver Spring, MD
  • NPI 1538717723

  Clinical, NC

  Medicare reassignment NPD
• Lifesource of North Carolina

  • Psychologist
  • Milton, FL
  • NPI 1730648288

  FL

  Medicare reassignment
• Lifesource of North Carolina

  • Internal Medicine Physician
  • Wilmington, NC
  • NPI 1811286156

  Clinical

  NPD
• Families United Services, Inc.

  • Community/Behavioral Health Agency
  • Fayetteville, GA
  • NPI 1720145030
  NPD (past)
• Linnel Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Elkridge, MD
  • NPI 1932795044
  NPD (past)

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

{
    "created_epoch": "1337212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734912000000",
    "number": "1417217092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 709",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302130709",
            "telephone_number": "770-969-2569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 REDMOND CIR NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651307",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Devant St",
            "address_2": "Suite 606",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "GA",
            "postal_code": "302142710",
            "country_code": "US",
            "telephone_number": "770-969-2569",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8040 Georgia Ave Ste 170",
            "address_purpose": "LOCATION",
            "city": "Silver Spring",
            "state": "MD",
            "postal_code": "209104959",
            "country_code": "US",
            "telephone_number": "202-360-4787",
            "fax_number": "202-360-4787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "WILLIE",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-17",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW004685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Monique Call, MD
• Alex Benjamin Callahan, APC, MA
• Abbey Camara
• Kelsey Cameron, M.S., BCBA
• Hannah Marie Campbell, CCC-SLP
• Christopher Michael Campos, DPT
• Kara Katelyn Campos, DPT
• Rachael Catherine Candela, DO
• Debra Cannon, M.D.
• Alexander Paul Capps, DO

• All providers in Rome, GA
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.