Healthcare Provider Details

I. General information

NPI: 1598994774
Provider Name (Legal Business Name): MELISSA BIRMINGHAM NOEL CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 S 8TH ST
GRIFFIN GA
30224-4214
US

IV. Provider business mailing address

670 S 8TH ST
GRIFFIN GA
30224-4214
US

V. Phone/Fax

Practice location:
  • Phone: 770-229-6498
  • Fax: 770-229-6958
Mailing address:
  • Phone: 770-229-6498
  • Fax: 770-229-6958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP006223
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: