Individual provider Active NPI

Angelia Holland-Dunning

  • Clinical Social Worker
  • Powder Springs, GA
National Provider Identifier
1669747267
Registry record updated Apr 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW005017 Issued in GA
Practice address
1539 Haven Crest Dr
Powder Springs
Powder Springs, GA 30127-4961
Phone
(317) 989-7370
NPI assigned
Mar 14, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X MSW005338 GA
Clinical Social Worker 1041C0700X CSW005017 GA Primary

Addresses

Primary practice location

1539 Haven Crest Dr
Powder Springs
Powder Springs, GA 30127-4961

Mailing address

1539 Haven Crest Dr
Powder Springs
Powder Springs, GA 30127-4961

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20231031000667 GA Practitioner - Clinical Social Worker 6204282072 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MSW005338GAMDSocial Worker
CSW005017GAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Lifesource of North Carolina Clinical CurrentSince Oct 16, 2023 Accepting new patients
Lifesource of North Carolina Clinical CurrentSince Oct 16, 2023 Accepting new patients

Locations

1345 Redmond Cir NW
Rome, GA 30165
Phone (706) 234-8281

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1331683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397606400000",
    "number": "1669747267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1539 HAVEN CREST DR",
            "address_2": "POWDER SPRINGS",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301274961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1539 HAVEN CREST DR",
            "address_2": "POWDER SPRINGS",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301274961",
            "telephone_number": "317-989-7370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLAND-DUNNING",
        "first_name": "ANGELIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-14",
        "last_updated": "2014-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "GA",
            "license": "MSW005338",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Powder Springs, GA

Sources for this page

Verify at the official NPI Registry.