Active NPI
Gwendolyn Thaggard
- Social Worker
- Hattiesburg, MS
National Provider Identifier
1417522889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- M9822
- Practice address
- 103 S 19TH Ave
Hattiesburg, MS 39401-6171 - Phone
- (601) 544-4641
- NPI assigned
- May 26, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | M9822 | MS | Primary |
Addresses
Primary practice location
103 S 19TH Ave
Hattiesburg, MS 39401-6171
Mailing address
4100 Mamie St
Hattiesburg, MS 39402-1735
Phone (601) 705-1906
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M9822 | MS | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621987200000",
"number": "1417522889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4100 MAMIE ST",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394021735",
"telephone_number": "601-705-1906",
"fax_number": "601-705-1952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 S 19TH AVE",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394016171",
"telephone_number": "601-544-4641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THAGGARD",
"first_name": "GWENDOLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-26",
"last_updated": "2021-05-26",
"certification_date": "2021-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MS",
"license": "M9822",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.