Michelle Gormally, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP003677 Issued in GA

Practice address

4411 Suwanee Dam Rd Ste 455
Suwanee, GA 30024-8706

Phone

(678) 714-6708

NPI assigned

May 4, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Special Needs Pediatric Therapy Services

  • Pediatric Physical Therapist
  • Suwanee, GA
  • NPI 1770754475
  NPD (past)

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1548472129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 GAINES OAK WAY",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300247356",
            "telephone_number": "770-364-5684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 SUWANEE DAM RD STE 455",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300248706",
            "telephone_number": "678-714-6708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORMALLY",
        "first_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP003677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000793185A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber K Goode, RDH, DDS
• Darrin L Goodwin, LPC
• Traci L Gordon
• Pamela Gorke
• Michael L Gorlovsky, D.M.D.
• Elena M Grant, LPC
• Cody Gray, DMD
• Rita Grayson, LCSW
• Greater Atlanta Monitoring, LLC
• Green Wellness RX LLC

• Speech-Language Pathologist in Suwanee, GA
• Providers in Suwanee, 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 Mar 16, 2023; 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.