Active NPI
Timothy James Whailen, LCSW
- Clinical Social Worker
- Hiram, GA
National Provider Identifier
1609445097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CSW007682
- Practice address
- 107 Enterprise Path Ste 301
Hiram, GA 30141-2690 - Phone
- (706) 509-0130
- Fax
- (706) 237-6503
- NPI assigned
- Jun 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CSW007682 | GA | Primary |
Addresses
Primary practice location
107 Enterprise Path Ste 301
Hiram, GA 30141-2690
Mailing address
9085 Clark Rd
Fairburn, GA 30213-1929
Phone (404) 480-3731
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CSW007682 | GA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627344000000",
"number": "1609445097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9085 CLARK RD",
"city": "FAIRBURN",
"state": "GA",
"postal_code": "302131929",
"telephone_number": "404-480-3731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 ENTERPRISE PATH STE 301",
"city": "HIRAM",
"state": "GA",
"postal_code": "301412690",
"telephone_number": "706-509-0130",
"fax_number": "706-237-6503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHAILEN",
"first_name": "TIMOTHY",
"middle_name": "JAMES",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-06-21",
"last_updated": "2021-07-27",
"certification_date": "2021-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "CSW007682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hiram, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.