Active NPI
Deborah Pender
- Clinical Social Worker
- Woodstock, GA
National Provider Identifier
1972352227
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- MSW011562
- Practice address
- 4595 Towne Lake Parkway
BLDG 300 Suite 130
Woodstock, GA 30189 - Phone
- (404) 661-2417
- NPI assigned
- May 17, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | MSW011562 | GA | Primary |
Addresses
Primary practice location
4595 Towne Lake Parkway
BLDG 300 Suite 130
Woodstock, GA 30189
Mailing address
4595 Towne Lake Parkway
BLDG 300 Suite 130
Woodstock, GA 30189
Phone (404) 661-2417
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MSW011562 | GA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715904000000",
"number": "1972352227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4595 TOWNE LAKE PARKWAY",
"address_2": "BLDG 300 SUITE 130",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "30189",
"telephone_number": "404-661-2417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4595 TOWNE LAKE PARKWAY",
"address_2": "BLDG 300 SUITE 130",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "30189",
"telephone_number": "404-661-2417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDER",
"first_name": "DEBORAH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-17",
"last_updated": "2024-05-17",
"certification_date": "2024-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "MSW011562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodstock, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.