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General NPI Number Information
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NPI Number | 1982592507
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Entity Type | Organization
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Legal Business Name | SAM CORLEY SPEECH LLC
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 3008 ORCHARD LN
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City | ATLANTA
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State | GA
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Zip | 30354-2452
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Country | US
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Telephone | 470-283-0604
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Fax |
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Provider Business Mailing Address
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Address Line | 3008 ORCHARD LN
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City | ATLANTA
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State | GA
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Zip | 30354-2452
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CASI J JOHNSON
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Credential |
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Telephone | 470-283-0604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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