Active NPI
Sage Matthew Jackson, M.A. CCC-SLP
- Speech-Language Pathologist
- Cumming, GA
National Provider Identifier
1871810432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP005650
- Practice address
- 1260 Smokehouse TRL
Cumming, GA 30041-9301 - Phone
- (404) 514-6654
- NPI assigned
- Apr 22, 2010
- 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 | SLP005650 | GA | Primary |
Addresses
Primary practice location
1260 Smokehouse TRL
Cumming, GA 30041-9301
Mailing address
1260 Smokehouse TRL
Cumming, GA 30041-9301
Phone (404) 514-6654
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP005650 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271894400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271894400000",
"number": "1871810432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1260 SMOKEHOUSE TRL",
"city": "CUMMING",
"state": "GA",
"postal_code": "300419301",
"telephone_number": "404-514-6654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1260 SMOKEHOUSE TRL",
"city": "CUMMING",
"state": "GA",
"postal_code": "300419301",
"telephone_number": "404-514-6654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SAGE",
"middle_name": "MATTHEW",
"credential": "M.A. CCC-SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-04-22",
"last_updated": "2010-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP005650",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cumming, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.