Individual provider Active NPI

Stacy Gayle Bura, CCC-SLP

  • Speech-Language Pathologist
  • Suwanee, GA
National Provider Identifier
1023456548
Registry record updated Jun 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP008054 Issued in GA
Practice address
5050 Research Court
Ste. 800
Suwanee, GA 30024
Phone
(770) 205-5551
NPI assigned
Jun 6, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SLP008054 GA Primary
Speech-Language Pathologist 235Z00000X 14065097 GA

Addresses

Primary practice location

5050 Research Court
Ste. 800
Suwanee, GA 30024

Mailing address

4870 La Moyne Lane
Alpharetta, GA 30022
Phone (404) 641-5091

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

State licenses

LicenseStateTypeSpecialty
14065097GAMDSpeech-Language Pathologist
SLP008054GAMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370476800000",
    "number": "1023456548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4870 LA MOYNE LANE",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "30022",
            "telephone_number": "404-641-5091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 RESEARCH COURT",
            "address_2": "STE. 800",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "30024",
            "telephone_number": "770-205-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURA",
        "first_name": "STACY",
        "middle_name": "GAYLE",
        "name_prefix": "Ms.",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-06",
        "last_updated": "2013-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP008054",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "14065097",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suwanee, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.