MEDICARE: SPEECH ASSESSMENT CENTER, 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	SLP006202	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	:	1467695734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH ASSESSMENT CENTER, INC.

Provider Business Mailing Address
First Line	:	210 MCINTOSH PLACE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7384
Country	:	US
Telephone Number	:	678-438-7168
Fax Number	:	707-377-8097

Provider Business Practice Location Address
First Line	:	175 BRADFORD SQ STE A
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-1967
Country	:	US
Telephone Number	:	678-438-7168
Fax Number	:	470-377-8097

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	JAMES NELSON
Credential	:
Telephone Number	:	678-438-7168

Provider Enumeration Date	:	04/15/2009
Last Update Date	:	12/11/2018

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Directions to “SPEECH ASSESSMENT CENTER, INC. ” Practice Location

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