Active NPI
Grant Devon Sparks
- Mental Health Counselor
- Chamblee, GA
National Provider Identifier
1598422883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 3720 Chamblee Dunwoody Rd Ste D2
Chamblee, GA 30341-2064 - Phone
- (678) 802-9355
- NPI assigned
- Nov 21, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
3720 Chamblee Dunwoody Rd Ste D2
Chamblee, GA 30341-2064
Mailing address
222 Turnbridge Cir
Peachtree City, GA 30269-6505
Phone (770) 312-2733
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 12, 2024 through Apr 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Modern Path. LLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637452800000",
"number": "1598422883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 TURNBRIDGE CIR",
"city": "PEACHTREE CITY",
"state": "GA",
"postal_code": "302696505",
"telephone_number": "770-312-2733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3720 CHAMBLEE DUNWOODY RD STE D2",
"city": "CHAMBLEE",
"state": "GA",
"postal_code": "303412064",
"telephone_number": "678-802-9355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPARKS",
"first_name": "GRANT",
"middle_name": "DEVON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-11-21",
"last_updated": "2021-11-21",
"certification_date": "2021-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chamblee, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.