Active NPI
Penny Long Harris, M. ED., CCC-SLP
- Speech-Language Pathologist
- Camilla, GA
National Provider Identifier
1427094622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 003443
- Practice address
- 3220 Highway 112
Camilla, GA 31730-4750 - Phone
- (229) 336-0742
- NPI assigned
- Jun 22, 2006
- Last updated
- Mar 18, 2013
- 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 | 003443 | GA | Primary |
Addresses
Primary practice location
3220 Highway 112
Camilla, GA 31730-4750
Mailing address
99 E Broad St
Camilla, GA 31730-1807
Phone (229) 336-8255
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00717417D | Medicaid | GA |
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
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003443 | GA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospital Authority of Mitchell County | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Archbold Mitchell
- Critical Access Hospital
- Camilla, GA
- NPI 1700830247
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363564800000",
"number": "1427094622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "99 E BROAD ST",
"city": "CAMILLA",
"state": "GA",
"postal_code": "317301807",
"telephone_number": "229-336-8255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3220 HIGHWAY 112",
"city": "CAMILLA",
"state": "GA",
"postal_code": "317304750",
"telephone_number": "229-336-0742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "PENNY",
"middle_name": "LONG",
"name_prefix": "Ms.",
"credential": "M. ED., CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-22",
"last_updated": "2013-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "003443",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00717417D",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Camilla, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.