Active NPI
Nicole Marie King, CCC-SLP
- Speech-Language Pathologist
- Dacula, GA
National Provider Identifier
1447326236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP004282
- Practice address
- 3615 Braselton Hwy Ste 103
Dacula, GA 30019-5907 - Phone
- (678) 377-9634
- Fax
- (678) 377-9609
- NPI assigned
- Nov 26, 2006
- 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 | SLP004282 | GA | Primary |
Addresses
Primary practice location
3615 Braselton Hwy Ste 103
Dacula, GA 30019-5907
Mailing address
3615 Braselton Hwy Ste 103
Dacula, GA 30019-5907
Phone (678) 377-9634
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000905407C | 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP004282 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244505600000",
"number": "1447326236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3615 BRASELTON HWY STE 103",
"city": "DACULA",
"state": "GA",
"postal_code": "300195907",
"telephone_number": "678-377-9634",
"fax_number": "678-377-9609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3615 BRASELTON HWY STE 103",
"city": "DACULA",
"state": "GA",
"postal_code": "300195907",
"telephone_number": "678-377-9634",
"fax_number": "678-377-9609"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "NICOLE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-26",
"last_updated": "2009-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP004282",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000905407C",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dacula, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.