Proactive Life & Health Services

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

PROACTIVE LIFE & HEALTH SERVICES

Doing business as

Shundra Burnes

Practice address

925 Main St Ste 300-50
Stone Mountain, GA 30083-3098

Phone

(404) 416-3547

Fax

(470) 867-6898

NPI assigned

Feb 12, 2020

Organization subpart

No

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

Authorized official

Name

Shundra Burnes, LCSWNPI 1033772140

Title

Owner/Organizer

Phone

(404) 416-3547

Specialties & licenses 1

Addresses

Other names 1

• Shundra Burnes Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shundra Burnes, LCSW

  • Clinical Social Worker
  • Stone Mountain, GA
  • NPI 1033772140
  NPD Authorized official

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

{
    "created_epoch": "1581465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1790317279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 MAIN ST STE 300-50",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833098",
            "telephone_number": "404-416-3547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 MAIN ST STE 300-50",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833098",
            "telephone_number": "404-416-3547",
            "fax_number": "470-867-6898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE LIFE & HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-12",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A",
        "authorized_official_last_name": "BURNES",
        "authorized_official_first_name": "SHUNDRA",
        "authorized_official_title_or_position": "OWNER/ORGANIZER",
        "authorized_official_telephone_number": "404-416-3547",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shundra Burnes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Social Worker in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2020; 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.