Mark Douglas, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

CSW007151 Issued in GA

Practice address

303 Fraser Dr
Hinesville, GA 31313-3712

Phone

(912) 877-2227

Fax

(912) 877-2332

NPI assigned

Jul 30, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Diversity Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Ludowici, GA
  • NPI 1952584708
  NPD (past)

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1508475062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 FINN CIR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314198408",
            "telephone_number": "912-308-6735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 FRASER DR",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313133712",
            "telephone_number": "912-877-2227",
            "fax_number": "912-877-2332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "213 N McDonald St Ste A&b",
            "address_purpose": "LOCATION",
            "city": "Ludowici",
            "state": "GA",
            "postal_code": "313166075",
            "country_code": "US",
            "telephone_number": "912-545-9398",
            "fax_number": "912-545-2747",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "244 Peachtree St",
            "address_purpose": "LOCATION",
            "city": "Jesup",
            "state": "GA",
            "postal_code": "315450212",
            "country_code": "US",
            "telephone_number": "912-385-2453",
            "fax_number": "912-559-2083",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "502 E General Stewart Way Ste A",
            "address_purpose": "LOCATION",
            "city": "Hinesville",
            "state": "GA",
            "postal_code": "313132643",
            "country_code": "US",
            "telephone_number": "912-368-1959",
            "fax_number": "912-368-1966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "GA",
            "license": "CSW007151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Social Worker in Hinesville, GA
• Providers in Hinesville, GA by specialty
• Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; 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.