Individual provider Active NPI

Shardasia Surles, LMSW

  • Mental Health Counselor
  • Fairburn, GA
National Provider Identifier
1740192632
Registry record updated Sep 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MSW011807 Issued in GA
Practice address
9008 Ashford CT
Fairburn, GA 30213-4746
Phone
(334) 412-2575
NPI assigned
Sep 17, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MSW011807 GA Primary

Addresses

Primary practice location

9008 Ashford CT
Fairburn, GA 30213-4746

Mailing address

9008 Ashford CT
Fairburn, GA 30213-4746
Phone (334) 412-2575

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

NPI Registry JSON

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

{
    "created_epoch": "1789603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789603200000",
    "number": "1740192632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9008 ASHFORD CT",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302134746",
            "telephone_number": "334-412-2575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9008 ASHFORD CT",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302134746",
            "telephone_number": "334-412-2575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURLES",
        "first_name": "SHARDASIA",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-09-17",
        "last_updated": "2026-09-17",
        "certification_date": "2026-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "MSW011807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairburn, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2026; 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.