Provider Demographics
NPI:1033508528
Name:GREATER ATLANTA SPEECH & LANGUAGE CLINICS, INC.
Entity Type:Organization
Organization Name:GREATER ATLANTA SPEECH & LANGUAGE CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:STORCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-977-9457
Mailing Address - Street 1:1515 JOHNSON FERRY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6492
Mailing Address - Country:US
Mailing Address - Phone:770-977-9457
Mailing Address - Fax:
Practice Address - Street 1:1515 JOHNSON FERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6492
Practice Address - Country:US
Practice Address - Phone:770-977-9457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP008754Medicaid