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General NPI Number Information
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NPI Number | 1073092144
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Entity Type | Individual
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Provider Name | JOEL RADER
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Gender | Male
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 1061 EUHARLEE RD
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City | EUHARLEE
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State | GA
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Zip | 30145-2807
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Country | US
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Telephone | 770-606-5871
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Fax |
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Provider Business Mailing Address
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Address Line | 593 MICHAEL CT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-5723
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Country | US
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Telephone | 470-503-6248
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | PCET002731
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License Number State | GA
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