Active NPI
Shilene Moultrie-Johnson, ED.D
- Professional Counselor
- Fayetteville, GA
National Provider Identifier
1285072470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1312032
- Practice address
- 190 Eli Run
Fayetteville, GA 30214-3723 - Phone
- (678) 382-4999
- Fax
- (770) 461-4306
- NPI assigned
- Jun 10, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1312032 | MA | Primary |
Addresses
Primary practice location
190 Eli Run
Fayetteville, GA 30214-3723
Mailing address
190 Eli Run
Fayetteville, GA 30214-3723
Phone (678) 382-4999
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TR-BFTS-1397 | Other | GA | GEORGIA TRAINING APPROVAL: |
| 03112367967 | Other | GA | AMERICAN HEART ASSOCIATION/ BLS INSTRUCTOR |
| 1312032 | Other | MA | TEACHER'S LICENSE |
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 |
|---|---|---|---|
| 1312032 | MA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370822400000",
"number": "1285072470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 ELI RUN",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302143723",
"telephone_number": "678-382-4999",
"fax_number": "770-461-4306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "190 ELI RUN",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302143723",
"telephone_number": "678-382-4999",
"fax_number": "770-461-4306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOULTRIE-JOHNSON",
"first_name": "SHILENE",
"name_prefix": "Dr.",
"credential": "ED.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-10",
"last_updated": "2013-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MA",
"license": "1312032",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEORGIA TRAINING APPROVAL:",
"identifier": "TR-BFTS-1397",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN HEART ASSOCIATION/ BLS INSTRUCTOR",
"identifier": "03112367967",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEACHER'S LICENSE",
"identifier": "1312032",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.