Active NPI
Andrea Thomas-Ingram, MS CCC-SLP
- Speech-Language Pathologist
- Lizella, GA
National Provider Identifier
1003030388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP003357
- Practice address
- 348 Hillridge CV
Lizella, GA 31052-3633 - Phone
- (478) 935-9433
- Fax
- (478) 935-9651
- NPI assigned
- Apr 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP003357 | GA | Primary |
Addresses
Primary practice location
348 Hillridge CV
Lizella, GA 31052-3633
Mailing address
348 Hillridge CV
Lizella, GA 31052-3633
Phone (478) 935-9433
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 366116 | Other | WELLCARE | |
| 115111 | Other | PEACH STATE HEALTH PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP003357 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003030388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "348 HILLRIDGE CV",
"city": "LIZELLA",
"state": "GA",
"postal_code": "310523633",
"telephone_number": "478-935-9433",
"fax_number": "478-935-9651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "348 HILLRIDGE CV",
"city": "LIZELLA",
"state": "GA",
"postal_code": "310523633",
"telephone_number": "478-935-9433",
"fax_number": "478-935-9651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS-INGRAM",
"first_name": "ANDREA",
"credential": "MS CCC-SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP003357",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "366116",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEACH STATE HEALTH PLAN",
"identifier": "115111",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Lizella, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.