Healthcare Provider Details

I. General information

NPI: 1225991920
Provider Name (Legal Business Name): REBECCA DIAMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11350 WOODSTOCK RD
ROSWELL GA
30075-7541
US

IV. Provider business mailing address

1750 HIGHGROVE CLUB DR
MILTON GA
30004-3193
US

V. Phone/Fax

Practice location:
  • Phone: 770-645-2340
  • Fax:
Mailing address:
  • Phone: 814-221-9164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP010750
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: