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General NPI Number Information
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NPI Number | 1821444043
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Entity Type | Organization
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Legal Business Name | GEORGIA SPEECH PATHOLOGY, LLC
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Dates
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Enumeration Date | 05/06/2016
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Last Update Date | 05/06/2016
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Provider Practice Location Address
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Address Line | 1616 PIEDMONT AVE NE APT. P12
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City | ATLANTA
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State | GA
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Zip | 30324-5298
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Country | US
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Telephone | 570-506-5421
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Fax |
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Provider Business Mailing Address
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Address Line | 1616 PIEDMONT AVE NE APT. P12
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City | ATLANTA
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State | GA
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Zip | 30324-5298
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Country | US
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Telephone | 570-506-5421
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. GEORGE MICHAEL TRAMONTANA
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Credential | M.S., CCC-SLP
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Telephone | 570-506-5421
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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 | SLP004945
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License Number State | GA
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