Active NPI
Nathaniel John Sundholm
- Speech-Language Pathologist
- Atlanta, GA
National Provider Identifier
1750804191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- PCET002530
- Practice address
- 550 Peachtree St NE
Atlanta, GA 30308-2212 - Phone
- (484) 686-1850
- NPI assigned
- Jul 18, 2017
- 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 | PCET002530 | GA | Primary |
Addresses
Primary practice location
550 Peachtree St NE
Atlanta, GA 30308-2212
Mailing address
964 52ND St
Brooklyn, NY 11219-4002
Phone (718) 810-3066
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 |
|---|---|---|---|
| PCET002530 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500336000000",
"number": "1750804191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "964 52ND ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112194002",
"telephone_number": "718-810-3066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 PEACHTREE ST NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303082212",
"telephone_number": "484-686-1850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUNDHOLM",
"first_name": "NATHANIEL",
"middle_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-18",
"last_updated": "2017-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "PCET002530",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.