Healthcare Provider Details

I. General information

NPI: 1235713967
Provider Name (Legal Business Name): ERIN KATHLEEN BYRNE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2021
Last Update Date: 05/09/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3597 KESWICK DR
ATLANTA GA
30341-2003
US

IV. Provider business mailing address

1640 EASTPORT TER SE
ATLANTA GA
30317-2402
US

V. Phone/Fax

Practice location:
  • Phone: 678-585-4715
  • Fax: 770-559-3974
Mailing address:
  • Phone: 615-498-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: