Healthcare Provider Details

I. General information

NPI: 1043383870
Provider Name (Legal Business Name): MS. MICHELE BARRI PLISKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3483 SATELLITE BLVD SUITE 304
DULUTH GA
30096-8692
US

IV. Provider business mailing address

486 LINDBERGH PL NE NO 317
ATLANTA GA
30324-3329
US

V. Phone/Fax

Practice location:
  • Phone: 770-418-1778
  • Fax:
Mailing address:
  • Phone: 770-418-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP006432
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: