MEDICARE: MRS. JANINE ELAINE JAMES M.ED. CCC-SLP

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	SLP006114	GA

General Provider Information

NPI Number	:	1164756698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANINE ELAINE JAMES M.ED. CCC-SLP

Provider Business Mailing Address
First Line	:	4673 CREEKSIDE CV
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-3936
Country	:	US
Telephone Number	:	404-209-2987
Fax Number	:

Provider Business Practice Location Address
First Line	:	4673 CREEKSIDE CV
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-3936
Country	:	US
Telephone Number	:	404-209-2987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	09/30/2009

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