Jeffrey Mark Duckworth, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW007902 Issued in GA

Practice address

377 Blackgum Trce
Dallas, GA 30132-5563

Phone

(770) 757-2716

NPI assigned

Dec 6, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, GA

  Medicare reassignment NPD
• Rogue Sun Counseling & Consulting, LLC

  • Clinical Social Worker
  • Dallas, GA
  • NPI 1962294553
  NPD

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

{
    "created_epoch": "1701820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1487421848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "377 BLACKGUM TRCE",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301325563",
            "telephone_number": "770-757-2716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "377 BLACKGUM TRCE",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301325563",
            "telephone_number": "770-757-2716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUCKWORTH",
        "first_name": "JEFFREY",
        "middle_name": "MARK",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-06",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "007902",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW007902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Douglas, RBT
• Courtney Danielle Downs
• Dr Eddy R Nestle D C Inc
• Drayer Physical Therapy Georgia LLC
• Dsi Hiram Home LLC
• Due Health LLC
• Jessica Duffey
• Sarah M Dungy, PT,DPT, OCS
• Joseph Mathew Dunn, D.C.
• Renee L Dunn, PT

• Clinical Social Worker in Dallas, GA
• Providers in Dallas, 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 Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.