Provider Demographics
NPI:1891433009
Name:JAMES, TIPHANIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TIPHANIE
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 PONCE DE LEON PL STE M #121
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3203
Mailing Address - Country:US
Mailing Address - Phone:404-590-4246
Mailing Address - Fax:
Practice Address - Street 1:235 PONCE DE LEON PL STE M #121
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3203
Practice Address - Country:US
Practice Address - Phone:404-590-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA19936235Z00000X
GASLP010701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist