Georgia Medical Speech Pathology Group

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

GEORGIA MEDICAL SPEECH PATHOLOGY GROUP

Practice address

1568 Spring Hollow Way
Stone Mountain, GA 30083-1333

Phone

(678) 654-1869

NPI assigned

Mar 23, 2023

Last updated

Mar 23, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jillian Hicks, M.S. , CCC-SLPNPI 1740639350

Title

Owner

Phone

(678) 654-1869

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jillian Hicks

  • Speech-Language Pathologist
  • Stone Mountain, GA
  • NPI 1740639350
  NPD Authorized official

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

{
    "created_epoch": "1679529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679529600000",
    "number": "1750084133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1568 SPRING HOLLOW WAY",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300831333",
            "telephone_number": "678-654-1869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1568 SPRING HOLLOW WAY",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300831333",
            "telephone_number": "678-654-1869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA MEDICAL SPEECH PATHOLOGY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-23",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "JILLIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-654-1869",
        "authorized_official_credential": "M.S. , CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Stone Mountain, GA
• Providers in Stone Mountain, 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 23, 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.