MEDICARE: PRIMARY PATHWAYS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP005791	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528485455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY PATHWAYS, LLC

Provider Business Mailing Address
First Line	:	2385 LAWRENCEVILLE HWY STE B-2
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3168
Country	:	US
Telephone Number	:	770-500-5508
Fax Number	:	404-597-4050

Provider Business Practice Location Address
First Line	:	2385 LAWRENCEVILLE HWY STE B-2
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3168
Country	:	US
Telephone Number	:	770-500-5508
Fax Number	:	404-597-4050

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JACQUELINE DENISE MURRY
Credential	:	PHD, CCC-SLP
Telephone Number	:	770-500-5508

Provider Enumeration Date	:	03/28/2014
Last Update Date	:	06/18/2020

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Directions to “PRIMARY PATHWAYS, LLC ” Practice Location

Language	Start Address	Practice Location

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