Active NPI
Shellie R Davis, CCC-SLP
- Speech-Language Pathologist
- Marietta, GA
National Provider Identifier
1962051979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP010725
- Practice address
- 790 Oak Trail Dr
Marietta, GA 30062-7502 - Phone
- (770) 212-2170
- Fax
- (770) 783-8639
- NPI assigned
- Sep 11, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | SLP010725 | GA | Primary |
Addresses
Primary practice location
790 Oak Trail Dr
Marietta, GA 30062-7502
Mailing address
7440 Highway 92
Woodstock, GA 30189-5235
Phone (770) 212-2170
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 |
|---|---|---|---|
| SLP010725 | GA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Moon River, LLC | Speech-Language Pathologist | Current | Accepting new patients |
Locations
7440 Highway 92
Woodstock, GA 30189
Phone (770) 212-2170
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568160000000",
"number": "1962051979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7440 HIGHWAY 92",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301895235",
"telephone_number": "770-212-2170",
"fax_number": "770-783-8639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "790 OAK TRAIL DR",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300627502",
"telephone_number": "770-212-2170",
"fax_number": "770-783-8639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "SHELLIE",
"middle_name": "R",
"name_prefix": "Ms.",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-09-11",
"last_updated": "2019-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP010725",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.