MEDICARE: GREATER ATLANTA SPEECH & LANGUAGE CLINICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP008754	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033508528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER ATLANTA SPEECH & LANGUAGE CLINICS, INC.

Provider Business Mailing Address
First Line	:	1515 JOHNSON FERRY RD STE 100
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-6492
Country	:	US
Telephone Number	:	770-977-9457
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 JOHNSON FERRY RD STE 100
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-6492
Country	:	US
Telephone Number	:	770-977-9457
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CAROL A STORCH
Credential	:
Telephone Number	:	770-977-9457

Provider Enumeration Date	:	01/21/2015
Last Update Date	:	01/21/2015

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