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General NPI Number Information
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NPI Number | 1508055708
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Entity Type | Individual
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Provider Name | MELODY B GOODSON CCC - SLP
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Gender | Female
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 3368 GREYSTONE WAY
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City | VALDOSTA
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State | GA
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Zip | 31605-1096
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Country | US
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Telephone | 229-242-6670
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Fax | 229-242-6671
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Provider Business Mailing Address
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Address Line | 3368 GREYSTONE WAY
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City | VALDOSTA
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State | GA
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Zip | 31605-1096
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Country | US
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Telephone | 229-242-6670
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Fax | 229-242-6671
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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 | SLP006378
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License Number State | GA
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