Healthcare Provider Details

I. General information

NPI: 1770818320
Provider Name (Legal Business Name): KERRI GOLDING, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 THORNTON RD R
LITHIA SPRINGS GA
30122-1558
US

IV. Provider business mailing address

561 THORNTON RD R
LITHIA SPRINGS GA
30122-1558
US

V. Phone/Fax

Practice location:
  • Phone: 404-849-6586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003105
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier103744492A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: KERRI LYNNE GOLDING
Title or Position: LCSW
Credential:
Phone: 404-849-6586