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General NPI Number Information
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NPI Number | 1366829137
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Entity Type | Organization
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Legal Business Name | RHONDA LANE GRAY THERAPY SERVICES,INC.
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 601 N BELAIR SQ #19
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City | EVANS
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State | GA
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Zip | 30809-4321
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Country | US
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Telephone | 706-833-7376
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Fax |
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Provider Business Mailing Address
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Address Line | 1036 BARRETT DR
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City | EVANS
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State | GA
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Zip | 30809-4029
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Country | US
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Telephone | 706-833-7376
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | RHONDA LANE GRAY
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Credential | M.A.C.C.C. S.L.P.
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Telephone | 706-833-7376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | SLP004870
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License Number State | GA
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