Healthcare Provider Details

I. General information

NPI: 1831031830
Provider Name (Legal Business Name): RAVEN GUNN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 HARBOR POINTE DR
STONE MOUNTAIN GA
30087-6176
US

IV. Provider business mailing address

249 HARBOR POINTE DR
STONE MOUNTAIN GA
30087-6176
US

V. Phone/Fax

Practice location:
  • Phone: 404-219-2909
  • Fax:
Mailing address:
  • Phone: 404-219-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. RAVEN NICOLE GUNN
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.S. CCC-SLP
Phone: 404-219-2909