MEDICARE: EMILY ANN O'GORMAN

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	SLP010355	GA

General Provider Information

NPI Number	:	1598382319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ANN O'GORMAN

Provider Business Mailing Address
First Line	:	2312 RIVER GREEN DR NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-3056
Country	:	US
Telephone Number	:	706-495-4581
Fax Number	:

Provider Business Practice Location Address
First Line	:	2312 RIVER GREEN DR NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-3056
Country	:	US
Telephone Number	:	706-495-4581
Fax Number	:

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

Provider Enumeration Date	:	06/27/2020
Last Update Date	:	06/27/2020

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Directions to “ EMILY ANN O'GORMAN ” Practice Location

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