Jalisa Nicole Rumph, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27766 Issued in MD

Practice address

316 Waxmyrtle Way
Perry, GA 31069-9478

Phone

(478) 297-1308

NPI assigned

Jun 22, 2021

Sex

Female

Sole proprietor

Yes

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 MD, GA2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761609600000",
    "number": "1508435603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 WAXMYRTLE WAY",
            "city": "PERRY",
            "state": "GA",
            "postal_code": "310699478",
            "telephone_number": "478-297-1308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 WAXMYRTLE WAY",
            "city": "PERRY",
            "state": "GA",
            "postal_code": "310699478",
            "telephone_number": "478-297-1308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUMPH",
        "first_name": "JALISA",
        "middle_name": "NICOLE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-22",
        "last_updated": "2025-10-28",
        "certification_date": "2025-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "27766",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW009845",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Revival Wound Specialists LLC
• Kaley Clark Reynolds
• Sophia Monique Roberts, MS
• Amanda Joy Rogers
• Clayton Reese Rountree
• Racheal Ann Ryan, BCBA
• Michelle Salkiewicz, CCC-SLP
• Michael F Salvia, MD
• Bruce Duwayne Sampson, MD
• Angela Christine Sanders, SLP

• Clinical Social Worker in Perry, GA
• Providers in Perry, 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 Oct 28, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.