Phyllis Jackson-Smith, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW1122 Issued in GA

Practice address

2995 Meadow Lark Dr
East Point, GA 30344-4033

Phone

(404) 762-7859

Fax

(404) 762-7859

NPI assigned

Apr 15, 2008

Last updated

Apr 15, 2008By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Senior Psych Solutions Corp

  • Clinical Social Worker
  • Atlanta, GA
  • NPI 1225078629
  NPD (past)

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

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208217600000",
    "number": "1427222041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 MEADOW LARK DR",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303444033",
            "telephone_number": "404-762-7859",
            "fax_number": "404-762-7859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2995 MEADOW LARK DR",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303444033",
            "telephone_number": "404-762-7859",
            "fax_number": "404-762-7859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON-SMITH",
        "first_name": "PHYLLIS",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-15",
        "last_updated": "2008-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW1122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Incredible Care
• Introspection Psychotherapy LLC
• It Starts Here, Inc.
• Gwendolyn Izell, M.A., CCC-SLP
• J. D Murray DDS & Associates P.C
• Charmeka Jackson
• Danielle Nicole Jackson, O.D.
• Kendall Jackson, SLP
• Stephen Jackson, M.D.
• Tiffany Jackson, LMSW

• Clinical Social Worker in East Point, GA
• Providers in East Point, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2008; 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.