Healthcare Provider Details

I. General information

NPI: 1205119179
Provider Name (Legal Business Name): MICHELE MCCORKLE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 10/09/2022
Certification Date: 10/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 PEACHTREE DUNWOODY RD NE BUILDING 400 , SUITE 125
ATLANTA GA
30328-6773
US

IV. Provider business mailing address

1514 CHAMBERLAIN AVE
CHATTANOOGA TN
37404-2911
US

V. Phone/Fax

Practice location:
  • Phone: 770-225-8421
  • Fax: 678-587-9993
Mailing address:
  • Phone: 423-304-6478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2341
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202010400
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: