Healthcare Provider Details

I. General information

NPI: 1750514402
Provider Name (Legal Business Name): MARY ANN MOKHEMAR SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LAKE HEARN DR NE SUITE 250
ATLANTA GA
30319-1415
US

IV. Provider business mailing address

540 CROSSBRIDGE ALY
JOHNS CREEK GA
30022-7535
US

V. Phone/Fax

Practice location:
  • Phone: 404-943-1070
  • Fax: 404-943-0890
Mailing address:
  • Phone: 678-691-5586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP000846
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: