Healthcare Provider Details

I. General information

NPI: 1548186448
Provider Name (Legal Business Name): ALYSSA CHESTER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RIVERSTONE DR STE B
CANTON GA
30114-5256
US

IV. Provider business mailing address

200 RIVERSTONE DR STE B
CANTON GA
30114-5256
US

V. Phone/Fax

Practice location:
  • Phone: 770-345-7796
  • Fax:
Mailing address:
  • Phone: 770-345-7796
  • Fax: 770-479-3471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPCET004550
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: