Keanna Nelson, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Fayetteville, GA
NPI 1386635191 · NPPES record last updated May 16, 2025
Key facts
- NPI
- 1386635191
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SLP006202 (GA)
- Practice address
- 175 Bradford SQ Ste a
Fayetteville, GA 30215 - Phone
- (678) 438-7168
- Fax
- (470) 377-8097
- NPI assigned
- Nov 1, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Qualified Speech Language Pathologist
- Education
- Other, 2004
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
7 Carnegie PLZ
Cherry Hill, NJ 08003-1000
7 Clyde Rd
Somerset, NJ 08873-5049
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120223000701 | GA | Practitioner - Qualified Speech Language Pathologist | 7113185034 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fox Rehabilitation Ga, LLC | Speech-Language Pathologist | Current |
Accepting new patients |
| Ability Rehab, LLC | Past |
Accepting new patients | |
| Ability Pro Therapy, LLC | Speech-Language Pathologist | Past |
Accepting new patients |
Locations
3090 Premiere Pkwy
Ste 400
Duluth, GA 30097
Phone (770) 624-2727
8601 Dunwoody Pl
Ste 130
Sandy Springs, GA 30350
Phone (404) 595-2034
7 Carnegie Plz
Cherry Hill, NJ 08003
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP006202 | GA | Yes |
Addresses
Primary practice location
175 Bradford SQ Ste a
Fayetteville, GA 30215
Mailing address
210 McIntosh Place Dr
Fayetteville, GA 30214-7384
Phone (678) 485-1470
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler | Other | Fox Rehabilitation GA, LLC |
| CONNECT URL | https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler | Other | Fox Rehabilitation GA, LLC |
| CONNECT URL | https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler | Other | Fox Rehabilitation GA, LLC |
Other providers in Fayetteville, GA
- National Medical Equipment & Supply Company LLC
- National Vision, Inc.
- Nations Health Services, Inc
- Matilda Nchifor
- Jonah Negusse
- Neurology Associates, P.C.
- New Generation Autistic and Behavioral Center LLC
- New Heights Behavioral Consultants, LLC
- New Hope Chiropractic Clinic, LLC
- Lauren Newbold
All providers in Fayetteville, GA · Speech-Language Pathologist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.