Individual provider Active NPI

Jamesia Mathis, LPC

  • Counselor
  • Lawrenceville, GA
National Provider Identifier
1902464373
Registry record updated May 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
LPC010955 Issued in GA
Practice address
175 Gwinnett Dr
Lawrenceville, GA 30046-8444
Phone
(678) 209-2394
NPI assigned
May 31, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X LPC010955 GA Primary

Addresses

Primary practice location

175 Gwinnett Dr
Lawrenceville, GA 30046-8444

Mailing address

2798 Peek Rd NW Apt 621
Atlanta, GA 30318-7970
Phone (404) 670-1445

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
I20240124003784 GA Practitioner - Mental Health Counselor 0042663221 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Mercer University School of Medicine, 2015
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

3350 Breckinridge Blvd
Suite 200
Duluth, GA 30096-4959
Phone (770) 962-8396

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Positive Impact Health Centers Inc CurrentSince Jan 1, 2024 Accepting new patients
Positive Impact Health Centers, Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

3350 Breckinridge Blvd
Ste 200
Duluth, GA 30096
Phone (770) 962-8396

3075 Breckinridge Blvd
Ste 415
Duluth, GA 30096
Phone (770) 962-8396

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/6123adb2-d0d2-485a-9dcf-5fba87efb2ef/

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1559260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559260800000",
    "number": "1902464373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2798 PEEK RD NW APT 621",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303187970",
            "telephone_number": "404-670-1445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 GWINNETT DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468444",
            "telephone_number": "678-209-2394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "JAMESIA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-31",
        "last_updated": "2019-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "GA",
            "license": "LPC010955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.