{
"Npi": {
"NPI": "1992044465",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MATHIS MEYER",
"FirstName": "SHANNON",
"MiddleName": "FAY",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "LCSW, CACII",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MATHIS MEYER",
"OtherFirstName": "SHANNON",
"OtherMiddleName": "FAY",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "LCSW, CACII",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "8735 DUNWOODY PL STE R",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30350-2995",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3478 MARTHA BERRY HWY NE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROME",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30165-7713",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-477-4888",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/04/2013",
"LastUpdateDate": "10/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "CSW005915",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}