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General NPI Number Information
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NPI Number | 1346888559
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Entity Type | Organization
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Legal Business Name | DANA PAULK
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 809 W 3RD ST
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City | OCILLA
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State | GA
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Zip | 31774-1740
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Country | US
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Telephone | 229-325-6450
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Fax |
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Provider Business Mailing Address
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Address Line | 809 W 3RD ST
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City | OCILLA
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State | GA
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Zip | 31774-1740
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Country | US
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Telephone | 229-325-6450
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANA P PAULK
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Credential | MED CCC-SLP
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Telephone | 229-325-6450
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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 |
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License Number State |
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