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NPI Code Detail

MEDICARE: MR. MASAYUKI IWAHASHI CCC-SLP

MEDICARE: MR. MASAYUKI IWAHASHI 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
1235Z00000XSpeech-Language PathologistSLP006220GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1SLP006220OTHERGASTATE BOARD OF EXAMINERS

General Provider Information

NPI Number : 1821261520
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MASAYUKI IWAHASHI CCC-SLP
Provider Business Mailing Address
First Line : 2600 HOLCOMB SPRINGS DR
Second Line :
City : ALPHARETTA
State : GA
Zip : 30022-5334
Country : US
Telephone Number : 404-431-8360
Fax Number :
Provider Business Practice Location Address
First Line : 404 KING SPRINGS VILLAGE PKWY SE
Second Line :
City : SMYRNA
State : GA
Zip : 30082-4240
Country : US
Telephone Number : 770-431-0816
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2008
Last Update Date : 04/02/2008

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