Edgar E Cordoba Jr., LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

MSW007376 Issued in GA

Practice address

22219 Panama City Beach Pkwy
Panama City Beach, FL 32413-3227

Phone

(850) 424-1923

NPI assigned

Jul 11, 2018

Last updated

Jul 11, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Journeypure Panhandle LLC

  dba JourneyPure Emerald Coast

  • Substance Abuse Rehabilitation Facility
  • Panama City Beach, FL
  • NPI 1326454786
  NPD (past)
• Journeypure Panhandle Medical Group LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Panama City, FL
  • NPI 1033567268
  NPD (past)

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

{
    "created_epoch": "1531267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1417433616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22219 PANAMA CITY BEACH PKWY",
            "city": "PANAMA CITY BEACH",
            "state": "FL",
            "postal_code": "324133227",
            "telephone_number": "850-424-1923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22219 PANAMA CITY BEACH PKWY",
            "city": "PANAMA CITY BEACH",
            "state": "FL",
            "postal_code": "324133227",
            "telephone_number": "850-424-1923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDOBA",
        "first_name": "EDGAR",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-11",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "MSW007376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Comfortable Care Dental Health Professionals, P.a. (Palmetto Dental)
• Comfortable Care Dental Health Professionals, P.a. (The Center for Cosmetic Dentistry - Panama City Beach)
• Comfortable Care Dental Health Professionals, P.a. (Beach Dental Studio)
• Comfortable Care Dental Health Professionals. P.a. (Breakfast Point Dental Care)
• Compass Physical Therapy
• Denise Elaine Corley, RBT
• Colby Courville, DPT
• Colleen Cox, MT-BC
• Kyle Kimbrough Cox, NP
• Guy Alvin Crawford, PA-C

• Clinical Social Worker in Panama City Beach, FL
• Providers in Panama City Beach, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; 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.