Carmellia Thomas Bumgardner, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C004066 Issued in NC

Practice address

351 Riverside Dr
Mount Airy, NC 27030-3850

Phone

(336) 786-7079

Fax

(336) 786-6312

NPI assigned

Jan 11, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495756800000",
    "number": "1770633679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 EXECUTIVE PARK DRIVE",
            "address_2": "STE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251833",
            "telephone_number": "704-939-1100",
            "fax_number": "704-939-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 RIVERSIDE DR",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270303850",
            "telephone_number": "336-786-7079",
            "fax_number": "336-786-6312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUMGARDNER",
        "first_name": "CARMELLIA",
        "middle_name": "THOMAS",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-11",
        "last_updated": "2017-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C004066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6003123",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Faye B Bryant, CRNA
• BT Heart and Vascular Center, PLLC (The Heart and Vascular Center)
• Carl Jon Buchholz, MD
• Mallory Vaughn Bukas
• Matthew Ryan Bullerman, COTA
• Madeline Riley Buontempo, CRNA
• Candace Haymore Burcham, FNP
• Catalin Burciu, MD
• Linda A Burk, M.D.
• Cathy Ann Burns, MSN, FNP-BC

• Clinical Social Worker in Mount Airy, NC
• Providers in Mount Airy, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2017; 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.