Active NPI
Michelle Tippens
- Speech-Language Pathologist
- Acworth, GA
National Provider Identifier
1245913680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- PCET003892
- Practice address
- 4900 Ivey Rd NW Ste 1720
Acworth, GA 30101-4101 - Phone
- (770) 917-5737
- NPI assigned
- Aug 11, 2023
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | PCET003892 | GA | Primary |
Addresses
Primary practice location
4900 Ivey Rd NW Ste 1720
Acworth, GA 30101-4101
Mailing address
1858 Hawks Ridge CT
Lawrenceville, GA 30043-6642
Phone (770) 601-3811
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 |
|---|---|---|---|
| PCET003892 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691712000000",
"number": "1245913680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1858 HAWKS RIDGE CT",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300436642",
"telephone_number": "770-601-3811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4900 IVEY RD NW STE 1720",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301014101",
"telephone_number": "770-917-5737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIPPENS",
"first_name": "MICHELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-11",
"last_updated": "2023-08-11",
"certification_date": "2023-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "PCET003892",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Acworth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.