Healthcare Provider Details

I. General information

NPI: 1013080514
Provider Name (Legal Business Name): AMANDA ZITO GRIFFIN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 GLENRIDGE DR NE BLDG 1, SUITE 133
ATLANTA GA
30328-5387
US

IV. Provider business mailing address

5825 GLENRIDGE DR NE BLDG 1, SUITE 133
ATLANTA GA
30328-5387
US

V. Phone/Fax

Practice location:
  • Phone: 404-513-3810
  • Fax: 404-902-5440
Mailing address:
  • Phone: 404-513-3810
  • Fax: 404-902-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number117884
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP005916
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: