Individual provider Active NPI

Gaynor L Butler

  • Clinical Social Worker
  • Atlanta, GA
National Provider Identifier
1861032922
Registry record updated Jan 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW005515 Issued in GA
Practice address
2900 Chamblee Tucker Rd BLDG 16
Atlanta, GA 30341-4148
Phone
(770) 939-1288
Fax
(770) 212-2203
NPI assigned
Jan 7, 2020
Last updated
Jan 7, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CSW005515 GA Primary

Addresses

Primary practice location

2900 Chamblee Tucker Rd BLDG 16
Atlanta, GA 30341-4148

Mailing address

2900 Chamblee Tucker Rd BLDG 16
Atlanta, GA 30341-4148
Phone (770) 939-1288

Other identifiers 1

IdentifierTypeStateIssuer
CSW005515OtherGAPROFESSIONAL LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address info@ubhsinc.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200302001811 GA Practitioner - Clinical Social Worker 1052748126 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sondermind Provider Network LLCGroup PAC ID 9537572490, 1,295 clinicians

Practice addresses (Care Compare)

3372 Peachtree Rd NE
Suite 115
Atlanta, GA 30326-1963
Phone (866) 630-0966

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CSW005515GAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Sondermind Provider Network LLC Clinical CurrentSince Sep 18, 2023 Accepting new patients

Locations

3348 Peachtree Rd NE
Ste 700
Atlanta, GA 30326
Phone (720) 712-7900

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1861032922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CHAMBLEE TUCKER RD BLDG 16",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303414148",
            "telephone_number": "770-939-1288",
            "fax_number": "770-212-2203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 CHAMBLEE TUCKER RD BLDG 16",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303414148",
            "telephone_number": "770-939-1288",
            "fax_number": "770-212-2203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "GAYNOR",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-07",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "CSW005515",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@ubhsinc.com",
            "affiliation": "N",
            "address_1": "2900 Chamblee Tucker Rd Bldg 16",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303414148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.