MEDICARE: CAPSTONE SPEECH THERAPY

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	SLP006727	GA

General Provider Information

NPI Number	:	1326407461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPSTONE SPEECH THERAPY

Provider Business Mailing Address
First Line	:	4062 PEACHTREE RD NE
Second Line	:	SUITE 121
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-3021
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4062 PEACHTREE RD NE
Second Line	:	SUITE 121
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-3021
Country	:	US
Telephone Number	:	404-909-5574
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DARLA DARTY
Credential	:
Telephone Number	:	404-909-5574

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	02/17/2016

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Directions to “CAPSTONE SPEECH THERAPY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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