Damon Graham Jr., LCSW
Individual provider Active NPI Clinical Social Worker · Coolidge, GA
NPI 1831545474 · NPPES record last updated May 12, 2016
Key facts
- NPI
- 1831545474
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- CSW005767 (GA)
- Practice address
- 635 Myron Hart Rd
Coolidge, GA 31738-2143 - Phone
- (229) 224-0655
- Fax
- (229) 941-5865
- NPI assigned
- May 12, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Christopher Dennis MD PLLC
Practice addresses (Care Compare)
1420 Milstead Rd NE
Conyers, GA 30012-3823
Phone (888) 515-3834
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160629001746 | GA | Practitioner - Clinical Social Worker | 9436440013 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CSW005767 | GA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christopher Dennis MD PLLC | Clinical | Current |
Accepting new patients |
Locations
1420 Milstead Rd NE
Conyers, GA 30012
Phone (770) 483-3902
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CSW005767 | GA | Yes |
Addresses
Primary practice location
635 Myron Hart Rd
Coolidge, GA 31738-2143
Mailing address
635 Myron Hart Rd
Coolidge, GA 31738-2143
Phone (229) 224-0655
Other providers in Coolidge, GA
- Damon Graham Jr
- Joshua D Flounoy
- Patricia Ann Flounoy
- Amanda Gandy
- Sylvia Holmes
- Catherine Basford Howell
- Tamara A Iacampo
- John D. Archbold Memorial Hospital, Inc.
- Premise Health of Georgia Medical PC
All providers in Coolidge, GA · Clinical Social Worker in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.