MEDICARE: PARIS C SHIELDS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	005835	GA
2	1041C0700X	Clinical Social Worker	CSW005676	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CSW005676	OTHER	GA	GEORGIA COMPOSITE BOARD OF PC, SW AND LMFT

General Provider Information

NPI Number	:	1114270436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARIS C SHIELDS LCSW

Provider Business Mailing Address
First Line	:	2704 N OAK ST BLDG J
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-1768
Country	:	US
Telephone Number	:	229-262-7333
Fax Number	:	229-262-7335

Provider Business Practice Location Address
First Line	:	100 N PATTERSON ST # 94
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-5570
Country	:	US
Telephone Number	:	229-300-7501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	05/02/2023

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Directions to “ PARIS C SHIELDS LCSW” Practice Location

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