MEDICARE: TONJA RENEE EDMOND SLP-CCC

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

General Provider Information

NPI Number	:	1760641005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONJA RENEE EDMOND SLP-CCC

Provider Business Mailing Address
First Line	:	3300 MEMORIAL DR STE D4D5
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-2700
Country	:	US
Telephone Number	:	404-289-4270
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 MEMORIAL DR STE D4D5
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-2700
Country	:	US
Telephone Number	:	404-289-4270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	01/29/2013

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Directions to “ TONJA RENEE EDMOND SLP-CCC” Practice Location

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