Healthcare Provider Details

I. General information

NPI: 1821401704
Provider Name (Legal Business Name): KEESHA SLEDGE SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 VETERANS BLVD
DUBLIN GA
31021-3620
US

IV. Provider business mailing address

706 VALLEYSIDE DR
DALLAS GA
30157-9391
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-1210
  • Fax:
Mailing address:
  • Phone: 205-563-6852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119102
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3007G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: