Active NPI
Candace Shepherd
- Clinical Social Worker
- Brunswick, GA
National Provider Identifier
1770901951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 004711
- Practice address
- 707 F Street
Brunswick, GA 31520 - Phone
- (912) 265-2055
- Fax
- (912) 265-2509
- NPI assigned
- Apr 3, 2014
- Sex
- Female
- Sole proprietor
- No
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 | 004711 | GA | Primary |
Addresses
Primary practice location
707 F Street
Brunswick, GA 31520
Mailing address
707 F Street
Brunswick, GA 31520
Phone (912) 265-2055
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 |
|---|---|---|---|
| 004711 | GA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Second Chance, Inc | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Brunswick, GA
- NPI 1932223302
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396483200000",
"number": "1770901951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 F STREET",
"city": "BRUNSWICK",
"state": "GA",
"postal_code": "31520",
"telephone_number": "912-265-2055",
"fax_number": "912-265-2509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 F STREET",
"city": "BRUNSWICK",
"state": "GA",
"postal_code": "31520",
"telephone_number": "912-265-2055",
"fax_number": "912-265-2509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "CANDACE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-03",
"last_updated": "2014-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "004711",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brunswick, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.