Provider Demographics
NPI:1114075371
Name:BRAND, MEREDITH IVY (MED CCC-SLP, COM)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:IVY
Last Name:BRAND
Suffix:
Gender:F
Credentials:MED CCC-SLP, COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 NORTHEAST EXPY NE STE 120
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2480
Mailing Address - Country:US
Mailing Address - Phone:404-228-8558
Mailing Address - Fax:404-228-8659
Practice Address - Street 1:1777 NORTHEAST EXPY NE STE 120
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2480
Practice Address - Country:US
Practice Address - Phone:404-228-8558
Practice Address - Fax:404-228-8659
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000860604AMedicaid
GA000860604DMedicaid