Active NPI
Joshua D Blackmon, M.ED.,CCC
- Speech-Language Pathologist
- Marietta, GA
National Provider Identifier
1619254869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP007558
- Practice address
- 1000 Johnson Ferry Rd
Suite A100
Marietta, GA 30068-2114 - Phone
- (770) 977-9457
- Fax
- (770) 977-5087
- NPI assigned
- Nov 15, 2011
- Sex
- Male
- 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 | SLP007558 | GA | Primary |
Addresses
Primary practice location
1000 Johnson Ferry Rd
Suite A100
Marietta, GA 30068-2114
Mailing address
1000 Johnson Ferry Rd
Suite A100
Marietta, GA 30068-2114
Phone (770) 977-9457
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 |
|---|---|---|---|
| SLP007558 | GA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Greater Atlanta Speech & Language Clinics, Inc. | Speech-Language Pathologist | 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 and National Provider Directory roles.
-
- Occupational Therapist
- Duluth, GA
- NPI 1326262437
Speech-Language Pathologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321315200000",
"number": "1619254869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 JOHNSON FERRY RD",
"address_2": "SUITE A100",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300682114",
"telephone_number": "770-977-9457",
"fax_number": "770-977-5087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 JOHNSON FERRY RD",
"address_2": "SUITE A100",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300682114",
"telephone_number": "770-977-9457",
"fax_number": "770-977-5087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKMON",
"first_name": "JOSHUA",
"middle_name": "D",
"credential": "M.ED.,CCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-11-15",
"last_updated": "2011-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP007558",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.