Healthcare Provider Details

I. General information

NPI: 1649182742
Provider Name (Legal Business Name): RUTH DEMELO MS, CF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 CEDARCREST RD
ACWORTH GA
30101-6213
US

IV. Provider business mailing address

2151 CEDARCREST RD
ACWORTH GA
30101-6213
US

V. Phone/Fax

Practice location:
  • Phone: 561-801-3148
  • Fax: 404-595-2422
Mailing address:
  • Phone: 561-801-3148
  • Fax: 404-595-2422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPCET004666
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: