MEDICARE: MEREDITH WHITE SPEECH PATHOLOGY, 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	252Y00000X	Early Intervention Provider Agency	SLP008909	GA

General Provider Information

NPI Number	:	1891145454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEREDITH WHITE SPEECH PATHOLOGY, INC

Provider Business Mailing Address
First Line	:	1955 CLIFF VALLEY WAY NE
Second Line	:	SUIT 245
City	:	ATLANTA
State	:	GA
Zip	:	30329-2476
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1955 CLIFF VALLEY WAY NE
Second Line	:	SUIT 245
City	:	ATLANTA
State	:	GA
Zip	:	30329-2476
Country	:	US
Telephone Number	:	404-228-8558
Fax Number	:

Authorized Official
Title or Position	:	SLP
Name	:	MRS. MEREDITH WHITE
Credential	:	M.ED. CCC-SLP, COM
Telephone Number	:	404-228-8558

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	06/14/2016

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