Active NPI
Marcia Hudgins Brock
- Speech-Language Pathologist
- Lagrange, GA
National Provider Identifier
1962626911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP003680
- Practice address
- 729 Ridgecrest Rd
Lagrange, GA 30240-2147 - Phone
- (706) 884-5246
- Fax
- (706) 443-1303
- NPI assigned
- Apr 12, 2007
- 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 | SLP003680 | GA | Primary |
Addresses
Primary practice location
729 Ridgecrest Rd
Lagrange, GA 30240-2147
Mailing address
729 Ridgecrest Rd
Lagrange, GA 30240-2147
Phone (706) 884-5246
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 |
|---|---|---|---|
| SLP003680 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962626911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "729 RIDGECREST RD",
"city": "LAGRANGE",
"state": "GA",
"postal_code": "302402147",
"telephone_number": "706-884-5246",
"fax_number": "706-443-1303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "729 RIDGECREST RD",
"city": "LAGRANGE",
"state": "GA",
"postal_code": "302402147",
"telephone_number": "706-884-5246",
"fax_number": "706-443-1303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCK",
"first_name": "MARCIA",
"middle_name": "HUDGINS",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP003680",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lagrange, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.