Phyllis J Jeter, LCSW
Individual provider Active NPI Clinical Social Worker · Rome, GA
NPI 1437100484 · NPPES record last updated Oct 16, 2019
Key facts
- NPI
- 1437100484
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- CSW002331 (GA)
- Practice address
- 1345 Redmond Cir NW
Rome, GA 30165-1307 - Phone
- (910) 742-9243
- Fax
- (888) 746-1787
- NPI assigned
- May 15, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060425000215 | GA | Practitioner - Clinical Social Worker | 6901816743 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CSW002331 | GA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifesource of North Carolina | Clinical | Current |
Accepting new patients |
| Lifesource of North Carolina | Clinical | Current |
Accepting new patients |
| Phoebe Putney Memorial Hospital, Inc. | Past | Accepting new patients | |
| Phoebe Putney Memorial Hospital, Inc. | Past | Accepting new patients |
Locations
1345 Redmond Cir NW
Rome, GA 30165
Phone (706) 234-8281
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CSW002331 | GA | Yes |
Addresses
Primary practice location
1345 Redmond Cir NW
Rome, GA 30165-1307
Mailing address
PO Box 538622
Atlanta, GA 30353-8622
Phone (910) 535-1211
Other practice location 1
910 N Jefferson St
Albany, GA 31701-2393
Phone (229) 312-7001
Other providers in Rome, GA
- Howard Whitney Jennings
- Sasha Fanchon Jennings
- Catrin Jensen
- Benjamin Chase Jessie
- Mark A Jester
- Jill Marie Jewett
- Stacey E Johlman
- John Azar-Dickens, PH.D.,PC
- John J. Beninato, D.D.S., P.C.
- John Marshall Jenkins PHD LLC
All providers in Rome, GA · Clinical Social Worker in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.