Active NPI
Kallie Nauertz
- Clinical Social Worker
- Roswell, GA
National Provider Identifier
1700441888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 1004 Bombay LN
Roswell, GA 30076-5820 - Phone
- (678) 288-6221
- NPI assigned
- May 5, 2019
- Sex
- Female
- 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 | GA | Primary |
Addresses
Primary practice location
1004 Bombay LN
Roswell, GA 30076-5820
Mailing address
1004 Bombay LN
Roswell, GA 30076-5820
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557014400000",
"number": "1700441888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1004 BOMBAY LN",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300765820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1004 BOMBAY LN",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300765820",
"telephone_number": "678-288-6221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAUERTZ",
"first_name": "KALLIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-05",
"last_updated": "2019-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roswell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2019; 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.