STEPHANIE BLACKETT NICHOLS LCSW
NPI 1053704072
Social Worker - Clinical in Augusta, GA
About Stephanie Blackett Nichols Lcsw NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
STEPHANIE BLACKETT NICHOLS LCSW (NPI 1053704072) is an individual clinical provider in Augusta, Georgia, licensed in Georgia (CSW005084) and active in the NPI registry since March 2015. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Stephanie Blackett Nichols Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Stephanie Nichols reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Atlanta, GA 30305
- Reassigned Medicare billing, Georgia enrollment
- 1,389 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30909 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 13
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
AUGUSTA, GA 30909
AUGUSTA, GA 30909
AUGUSTA, GA 30909
AUGUSTA, GA 30909
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Stephanie Nichols's NPI number?
The NPI number for Stephanie Nichols is 1053704072. It was assigned to this individual provider in the NPPES registry on March 16, 2015.
Where is Stephanie Nichols located?
Stephanie Nichols practices at 3540 Wheeler Rd Suite 619, Augusta, GA 30909. The listed phone number is (706) 733-0333.
What is Stephanie Nichols's specialty?
The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.
Is Stephanie Nichols enrolled in Medicare?
Yes. Stephanie Nichols is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Stephanie Nichols's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Stephanie Nichols reassigns Medicare benefits to The Southeast Permanente Medical Group (Atlanta, GA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Stephanie Nichols's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Stephanie Nichols was last updated on June 11, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Stephanie Blackett Nichols, LCSW · NPI 1053704072
Clinical provider in Augusta, Georgia. Individual provider, active in the CMS NPPES registry since March 16, 2015.
## Identity
- **NPI:** 1053704072 (Entity type: Individual)
- **Enumerated:** March 16, 2015
- **Primary specialty:** Social Worker - Clinical · taxonomy 1041C0700X
- **State license:** CSW005084 (Georgia)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 3540 WHEELER RD, SUITE 619, Augusta, GA 30909-1871
- **Phone:** (706) 733-0333
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** The Southeast Permanente Medical Group (NPI 1245266956, Atlanta, GA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 11, 2015
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Source: [NPI Profile](https://npiprofile.com/npi/1053704072) · Data from the CMS NPPES public registry.