Jackson K Edwards, DMIN., LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW006235 Issued in GA

Practice address

650 Henderson Dr Ste 430
Cartersville, GA 30120-3760

Phone

(404) 334-5859

NPI assigned

Aug 11, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Creative Family Care Inc.

  • Clinical Social Worker
  • Kennesaw, GA
  • NPI 1487149340
  NPD Authorized official

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1942686175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 SHILOH RD NW STE 3030",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301447186",
            "telephone_number": "404-334-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 HENDERSON DR STE 430",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301203760",
            "telephone_number": "404-334-5859"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "650 Henderson Dr Ste 430",
            "address_purpose": "LOCATION",
            "city": "Cartersville",
            "state": "GA",
            "postal_code": "301203760",
            "country_code": "US",
            "telephone_number": "404-334-5859",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1275 Shiloh Rd NW Ste 3030",
            "address_purpose": "LOCATION",
            "city": "Kennesaw",
            "state": "GA",
            "postal_code": "301447186",
            "country_code": "US",
            "telephone_number": "404-334-5859",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "JACKSON",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DMIN., LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-11",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "GA",
            "license": "MSW006645",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW006235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Cartersville, GA
• Providers in Cartersville, 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 Jun 26, 2018; 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.