Provider Demographics
NPI:1932619285
Name:MPM CREATIVE, LLC
Entity Type:Organization
Organization Name:MPM CREATIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:MM, MS, CCC-SLP
Authorized Official - Phone:678-467-7732
Mailing Address - Street 1:1560 HEWATT RD SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1922
Mailing Address - Country:US
Mailing Address - Phone:678-467-7732
Mailing Address - Fax:
Practice Address - Street 1:1560 HEWATT RD
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047
Practice Address - Country:US
Practice Address - Phone:678-467-7732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008511235Z00000X
SC5593235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty