Primary Pathways, LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP005791 Issued in GA

Legal business name

PRIMARY PATHWAYS, LLC

Practice address

1258 Concord Rd SE Ste 104
Smyrna, GA 30080-4302

Phone

(770) 500-5508

Fax

(404) 597-4050

NPI assigned

Apr 4, 2012

Organization subpart

No

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

Authorized official

Name

Jacqueline D Murry, PH.D.

Title

Agent

Phone

(770) 500-5508

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Primary Pathways Speech & Language Services, LLC Other name

Electronic endpoints 1

Tax ID family

Primary Pathways LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Primary Pathways, LLC

  • Speech-Language Pathologist
  • Decatur, GA
  • NPI 1528485455
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tonja Renee Edmond, SLP-CCC

  • Speech-Language Pathologist
  • Decatur, GA
  • NPI 1760641005
  NPD (past)
• Erika Laibson Kabu

  • Speech-Language Pathologist
  • Decatur, GA
  • NPI 1770829426
  NPD (past)

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

{
    "created_epoch": "1333497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592438400000",
    "number": "1649536640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3904 N DRUID HILLS RD # 214",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300333105",
            "telephone_number": "770-500-5508",
            "fax_number": "404-597-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1258 CONCORD RD SE STE 104",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300804302",
            "telephone_number": "770-500-5508",
            "fax_number": "404-597-4050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY PATHWAYS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-04",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A",
        "authorized_official_last_name": "MURRY",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "770-500-5508",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP005791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "674689092D",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Smyrna",
            "affiliation": "N",
            "address_1": "Primary Pathways Speech & Language Services, LLC",
            "address_2": "1258 Concord Rd SE, Suite 104",
            "city": "Smyrna",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Primary Pathways Speech & Language Services, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Speech-Language Pathologist in Smyrna, GA
• Providers in Smyrna, 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 Jun 18, 2020; 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.