Active NPI
Keon Shavers
- Mental Health Counselor
- Lithonia, GA
National Provider Identifier
1851779037
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Jan 20, 2021.
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 818 Shadow Lake Dr
Lithonia, GA 30058-3230 - Phone
- (404) 710-3918
- NPI assigned
- May 8, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
818 Shadow Lake Dr
Lithonia, GA 30058-3230
Mailing address
818 Shadow Lake Dr
Lithonia, GA 30058-3230
Phone (404) 710-3918
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431043200000",
"number": "1851779037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "818 SHADOW LAKE DR",
"city": "LITHONIA",
"state": "GA",
"postal_code": "300583230",
"telephone_number": "404-710-3918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "818 SHADOW LAKE DR",
"city": "LITHONIA",
"state": "GA",
"postal_code": "300583230",
"telephone_number": "404-710-3918"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAVERS",
"first_name": "KEON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-05-08",
"last_updated": "2015-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lithonia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.