Healthcare Provider Details

I. General information

NPI: 1134980063
Provider Name (Legal Business Name): DEMI SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 ABUTMENT RD
DALTON GA
30721-4680
US

IV. Provider business mailing address

1034 E LAKESHORE DR
DALTON GA
30720-5273
US

V. Phone/Fax

Practice location:
  • Phone: 706-271-6282
  • Fax:
Mailing address:
  • Phone: 706-618-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP012885
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: