Healthcare Provider Details

I. General information

NPI: 1760270433
Provider Name (Legal Business Name): CARSON GRIFFITH SMITH CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14557 US-19 SUITE C,
GRIFFIN GA
30224
US

IV. Provider business mailing address

2575 KENDRICK RD
ZEBULON GA
30295-6807
US

V. Phone/Fax

Practice location:
  • Phone: 770-468-6941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP013485
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: