Active NPI
India Jackson
- Speech-Language Pathologist
- Lawrenceville, GA
National Provider Identifier
1861210775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP013295
- Practice address
- 545 Old Norcross Rd Ste 200
Lawrenceville, GA 30046-3390 - Phone
- (678) 377-2833
- Fax
- (678) 502-7800
- NPI assigned
- Sep 30, 2024
- 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 | SLP013295 | GA | Primary |
Addresses
Primary practice location
545 Old Norcross Rd Ste 200
Lawrenceville, GA 30046-3390
Mailing address
6315 Robins Trce
Stone Mountain, GA 30087-4979
Phone (404) 414-0866
Other practice location 1
3715 Harrison Rd
Loganville, GA 30052-8739
Phone (678) 377-2833
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 |
|---|---|---|---|
| SLP013295 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727913600000",
"number": "1861210775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6315 ROBINS TRCE",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300874979",
"telephone_number": "404-414-0866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "545 OLD NORCROSS RD STE 200",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300463390",
"telephone_number": "678-377-2833",
"fax_number": "678-502-7800"
}
],
"practiceLocations": [
{
"address_1": "3715 Harrison Rd",
"address_purpose": "LOCATION",
"city": "Loganville",
"state": "GA",
"postal_code": "300528739",
"country_code": "US",
"telephone_number": "678-377-2833",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "INDIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-30",
"last_updated": "2024-10-03",
"certification_date": "2024-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP013295",
"primary": true
}
],
"identifiers": [],
"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 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.