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NPI Code Detail

MEDICARE: JANNIE GRAHAM SLP

MEDICARE:   JANNIE  GRAHAM  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
1235Z00000XSpeech-Language PathologistSLP005929GA

General Provider Information

NPI Number : 1356329643
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANNIE GRAHAM SLP
Provider Business Mailing Address
First Line : 2500 SHALLOWFORD RD NE
Second Line : #4311
City : ATLANTA
State : GA
Zip : 30345-1226
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 675 SEMINOLE AVE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30307-3408
Country : US
Telephone Number : 404-575-4000
Fax Number : 404-575-4010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 07/08/2007

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Directions to “ JANNIE GRAHAM SLP” Practice Location

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