Active NPI
Palace Zinnermon McMichael
- Behavior Technician
- Jonesboro, GA
National Provider Identifier
1235765637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 18-61059
- Practice address
- 8540 Sheridan Dr
Jonesboro, GA 30236-3739 - Phone
- (762) 235-8312
- NPI assigned
- Mar 17, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 18-61059 | GA | Primary |
Addresses
Primary practice location
8540 Sheridan Dr
Jonesboro, GA 30236-3739
Mailing address
8540 Sheridan Dr
Jonesboro, GA 30236-3739
Phone (762) 235-8312
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Jonesboro | Other | |
| Other URL | Jonesboro | Other |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 18-61059 | GA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584403200000",
"number": "1235765637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8540 SHERIDAN DR",
"city": "JONESBORO",
"state": "GA",
"postal_code": "302363739",
"telephone_number": "762-235-8312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8540 SHERIDAN DR",
"city": "JONESBORO",
"state": "GA",
"postal_code": "302363739",
"telephone_number": "762-235-8312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZINNERMON MCMICHAEL",
"first_name": "PALACE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-17",
"last_updated": "2020-03-17",
"certification_date": "2020-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "18-61059",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Jonesboro",
"affiliation": "N",
"endpointDescription": "residence",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "Jonesboro",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Jonesboro",
"address_1": "8540 Sheridan Dr",
"city": "Jonesboro",
"state": "GA",
"country_code": "US",
"postal_code": "302363739",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Jonesboro",
"affiliation": "N",
"endpointDescription": "residence",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "Jonesboro",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Jonesboro",
"address_1": "8540 Sheridan Dr",
"city": "Jonesboro",
"state": "GA",
"country_code": "US",
"postal_code": "302363739",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Jonesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.