Provider Demographics
NPI:1013019546
Name:MCGRATH, CARL O (MA, PHD, CCC-S)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:O
Last Name:MCGRATH
Suffix:
Gender:M
Credentials:MA, PHD, CCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 SIMONTON DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-2579
Mailing Address - Country:US
Mailing Address - Phone:706-769-3400
Mailing Address - Fax:
Practice Address - Street 1:1031 SIMONTON DR
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-2579
Practice Address - Country:US
Practice Address - Phone:706-769-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist