Active NPI
Heather Mullis, CCC-SLP
- Speech-Language Pathologist
- Lawrenceville, GA
National Provider Identifier
1851543490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 6927
- Practice address
- 65 Darcee CT
Lawrenceville, GA 30045-7402 - Phone
- (678) 858-4777
- Fax
- (678) 985-3953
- NPI assigned
- Oct 14, 2008
- Sex
- Female
- 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 | 6927 | GA | Primary |
Addresses
Primary practice location
65 Darcee CT
Lawrenceville, GA 30045-7402
Mailing address
4370 Satellite Blvd Apt 620
Duluth, GA 30096-4060
Phone (678) 858-4777
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 226858618A | Medicaid | GA |
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 |
|---|---|---|---|
| 6927 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223942400000",
"number": "1851543490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4370 SATELLITE BLVD APT 620",
"city": "DULUTH",
"state": "GA",
"postal_code": "300964060",
"telephone_number": "678-858-4777",
"fax_number": "678-985-3953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 DARCEE CT",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300457402",
"telephone_number": "678-858-4777",
"fax_number": "678-985-3953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLIS",
"first_name": "HEATHER",
"name_prefix": "Mrs.",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-14",
"last_updated": "2008-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "6927",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "226858618A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.