George Deshazor

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904000760 Issued in VA

Practice address

707 N Courthouse Rd
North Chesterfield, VA 23236-4045

Phone

(804) 924-2236

Fax

(866) 626-4469

NPI assigned

Jan 19, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1611014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1497345078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 N COURTHOUSE RD",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232364045",
            "telephone_number": "804-924-2236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N COURTHOUSE RD",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232364045",
            "telephone_number": "804-924-2236",
            "fax_number": "866-626-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESHAZOR",
        "first_name": "GEORGE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-19",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904000760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "myspectrumcredentialing@myspectrumcc.com",
            "affiliation": "N",
            "address_1": "707 N Courthouse Rd",
            "city": "North Chesterfield",
            "state": "VA",
            "country_code": "US",
            "postal_code": "232364045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Social Worker in North Chesterfield, VA
• Providers in North Chesterfield, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.

Verify at the official NPI Registry.