MEDICARE: VILLAGE PATHWAYS COMPREHENSIVE THERAPY, 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	SLP005791	OTHER	GA	STATE LICENSE

General Provider Information

NPI Number	:	1730551219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE PATHWAYS COMPREHENSIVE THERAPY, LLC

Provider Business Mailing Address
First Line	:	2385 LAWRENCEVILLE HWY STE B
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3168
Country	:	US
Telephone Number	:	404-289-4270
Fax Number	:	404-393-2424

Provider Business Practice Location Address
First Line	:	2385 LAWRENCEVILLE HWY STE B
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3168
Country	:	US
Telephone Number	:	404-289-4270
Fax Number	:	404-393-2424

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACQUELINE D MURRY
Credential	:	PHD, CCC-SLP
Telephone Number	:	404-289-4270

Provider Enumeration Date	:	10/23/2015
Last Update Date	:	10/23/2015

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Directions to “VILLAGE PATHWAYS COMPREHENSIVE THERAPY, LLC ” Practice Location

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