Active NPI
Dewayne Fletcher, LCSW
- Clinical Social Worker
- Valdosta, GA
National Provider Identifier
1467281154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CSW009078
- Practice address
- 3120 N Oak Street Ext Ste B
Valdosta, GA 31602-5910 - Phone
- (229) 671-6112
- NPI assigned
- Jul 30, 2024
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CSW009078 | GA | Primary |
Addresses
Primary practice location
3120 N Oak Street Ext Ste B
Valdosta, GA 31602-5910
Mailing address
3120 N Oak Street Ext Ste B
Valdosta, GA 31602-5910
Phone (229) 671-6112
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 |
|---|---|---|---|
| CSW009078 | GA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722297600000",
"number": "1467281154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3120 N OAK STREET EXT STE B",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316025910",
"telephone_number": "229-671-6112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3120 N OAK STREET EXT STE B",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316025910",
"telephone_number": "229-671-6112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLETCHER",
"first_name": "DEWAYNE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-30",
"last_updated": "2024-07-30",
"certification_date": "2024-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "CSW009078",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valdosta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.