Jamequa A Stallworth

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP009469 Issued in GA

Practice address

4460 Celebration Blvd
Acworth, GA 30101-1105

Phone

(800) 696-3904

NPI assigned

May 10, 2018

Last updated

May 10, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525910400000",
    "number": "1336639889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 HUNTERS POINTE CT",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301804408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4460 CELEBRATION BLVD",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301011105",
            "telephone_number": "800-696-3904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLWORTH",
        "first_name": "JAMEQUA",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-10",
        "last_updated": "2018-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP009469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Acworth, GA
• Providers in Acworth, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2018; 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.